Single Payer Health Systems

Step 1: I would suggest that first we lower the age of medicare to about 60 or so. Also, put a prohibition on companies forcibly moving their employees off of the company insurance plans, onto medicare until they are 65. It could be arranged that employed people that ELECTED to switch, be able to do so on a "before tax basis" through their employers. (It'd be a bit like a FICA deduction).

Step Two: Probably about 2 - 5 years after that, allow "buy in" to medicare as an alternative form of employee health insurance for companies smaller than some target number (50, 20, 5, whatever). Self employed people would probably be all over this. You'll have a small issue having to do with "family plans" since there is no such thing in medicare (that I am aware but the system changes all the darn time).

Step Three: Establish a schedule for slowly lowering the eligibility age down to about 50 or so. It phases in over 5 years or so. Again, it will have to be discussed how and whether companies with existing health plans can "push" employees over to medicare. Some where in here we may want to "allow" this, but only if the company is paying some portion of the cost commensurate with the costs of their own plans.

Step Four: Pretty much "clean up". This is probably a good 10 - 15 years in, but it becomes time for medicare for "all". And this still won't be "all" because there will be Veterans care and Tri-care and all of that. Various municipalities may still be on some form of specific "private" insurance for their employees. Retirees that have access to union benefits or something may be some of the last to be phased out.

A big part of this process is so that the costs get picked up "correctly", in the sense that as companies are unburdened of the responsibility of providing health insurance, it doesn't just become another big windfall for their profit margins. It also allows a transition period for the entire health care and insurance markets. Such changes could have large benefits for hospitals and doctors and we're gonna want those savings to get to the market to control costs to medicare so as that it doesn't appear more expensive than it truly is. Union contracts also need time to be renegotiated. And health insurance companies are going to morph into medicare plan management services for the government.