I found this fantastic policy paper on how states can move forward on getting to universal health coverage.
Some great ideas in this paper (sponsored by the National Academy for State Health Policy), including one of my favorites: setting up a universal single-payer in a rural area based on the local provider system, not on the local jurisdiction. The local provider (like a hospital in a rural area) would get all the funds that are currently put into health care, would be governed by a board that represents all payers and would be responsible for providing care to every single resident in the area.
We sort of do this on college campuses. That might be a good place to expand -- rural college towns.
Another idea is to set up a narrow set of benefits that are universally available (everyone gets one physical exam), instead of trying to get a full or comprehensive set of benefits for everyone. This one-step-at-a-time approach appeals to me, as a big impediment to universal health coverage is the sense among lots of people that government programs are for poor people, not for the middle-class. The more we can change that about health care (no one thinks that government programs about street lights, sewers or airports are for poor people), the better off we are.
Evidence-based medicine is also a big deal, and there are thoughts that states should share their data more. For example, some states have a preferred drug list. Why shouldn't all states share that data?
It seems to me that spending public money on health coverage should be an economic development tool. Come here, company, to our state, and you won't have to pay for health insurance for your employers. It's already covered! Or, come here, small entreprenuer and set up your creative enterprise. Your health insurance is covered. Why are we only chasing after big corporations with tax breaks for economic development? Why don't we put that money into universal health insurance to attract people and businesses?
Another little nugget: Canada got universal health coverage by starting in one province: Saskatchewan. And that province only started by covering hospital services. Over time, the benefit broadened, and it went nationwide.
A final nugget: we might start with a different model of health coverage with public employees. They are not federally funded at all, so restrictive federal laws do not apply. An innovative state could set up a universal program for all state (and local?) employees and build out from there. Because employer-centered health coverage is probably on the way out.