I liked your idea immediately the first time I saw you suggest it. It is a way out the money-driven medicine mess that really could work. Working like this--as more people signed up, they would hire more doctors and it would eventually get better and better, both drawing newly minted docs not in it for the money and more people signing up. Private insurance and practice continues to escalate in cost, more people opt for it. We end up most people in a National Health system with wealthier people opting out or people buying extra plans if they want fancier services , just like in the UK

Big glitch: the government has to have a desire to fund its growth. The GOP would be attacking it all the time, every day in every way. It would be a great help if it got into doctor/practitioner training, too, so all new docs are not money-driven maniacs because of their debts (and a pony.)

Still, it really is a good solution to the Medicare fee-for-service mess that drives money-driven medicine. It's going to be hell trying to get people to give an inch of that up. A VA competitor to it for the under 65 would acclimate those folks to a NHS type scenario before they retire, and also if successful, draw more and more practioners out of the open market, so that Medicare's "free choice" doesn't look so swell any more. Where people would start thinking what good is choice of things like brand name drugs and MRI's for every sprain if you can't get an appointment without waiting 6 months and the big name specialists won't accept your Medicare payment any longer? But it would have to be funded well as it grows, there's the problem.

P.S. I liked it especially as a counter-narrative to the cries of" Medicare for all." Without reforming Medicare first, I saw that as people knowing not of what they spoke. That would be a disaster in the making. Not the least of which a lot of people would have sticker shock at what the rates would be for non-retired unsubsidized.. As you can see from the Times' chart, fee-for-service is very very expensive. But it could also end up killing all government involvment in medicine as costs skyrocketed to crazy levels. That's because it's the main thing causing money-driven medicine. For profit insurance follows Medicare's lead, i.e., if Medicare refuses to cover Provenge, they can too, if Medicare covers Provenge, they get grief if they don't. A VA type system hopefully just says--we don't cover Provenge, it you want it, go pay for a private health plan.