It is so darned simple yet nobody seems to twig. The traditional employment model is not there. More and more people are becoming self supplied(we eat what we kill so to speak) We generate our own income rather than have an employer. Every study suggests our ranks will grow either out of choice or circumstance. An employment based health system is seeking a solution in the rear view mirror. Only wide open competition will be able to cause the adjustments required to supply an Independantly employed force with no homogenity. This suggests a real change of thinking. Going full market to allow new models.  I personally favor niche market insurers with an active financial market that would allow the underwriter to lay off a good portion of their risk to speculators to keep premiums down on a wide array of choices for the consumer. But this is just me others might and should have other ideas.