>>People who can afford normal care- broken bones - e.g. my recent toe calamity- and sinus issues should just pay for them. They should take catastrophic insurance for expenses over their limits.

Assuming we're not talking about the 1%: IMHO acute and trauma always need cost sharing for high standard timely care, but sinus issues? For non-acute secondary care, go for a universal service using a waiting list as a rationing mechanism. Those who won't wait and can afford to pay will self-select themselves into a paying stream, which shortens the wait for everybody else. The alternative of trying to decree who can or can't afford to pay, is stymied by human nature: no sooner do you advertise who won't be subsidized any more because they "can afford normal care" than your fellow recipients are maneuvering their affairs to demonstrate how poor they are- if they haven't already. Believe me, there are past masters at this in every scheme that tries to re-target subsidies. Meanwhile the moral risk of denying care to somebody who you think ought to be able to pay but cannot for whatever reason, is antisocial.

>>I suspect that here in the US that will vary by state and that's a good thing.
>>I probably have more in common with someone in London than someone in Oklahoma. Those Oklahomans should decide what's best for themselves.

The more those Oklahomans know, the more they'll realize they don't know. Maybe check out how Switzerland runs itself via cantons but centralizes authority for things that affect all Swiss.

>>Seniors are a different matter and talking about them while talking about 45 year olds just muddies things.

If the 45 year old wasn't saddled with the seniors' Ponzi scheme, there would be more for him/herself. That Medicare deficit can't just be broad brushed away when it's the size of a planet whose gravity distorts everything.