There is no way, not a single path, through which a private, for-profit health insurance company can compete with Medicare and/or Medicaid for value for insurance dollar spent. If Medicare and/or Medicaid rates were available on the exchanges, it would be obvious to even the most myopic of minds that those two health care insurance providers provide the same basic health care benefits as their private insurance counterparts at substantially less cost (the exception to this will be Dubya's gift to the health insurance industry for the prescription drug benefit). Once the CIEFO class sees that, it's curtains for private health insurers. Everyone would sign up for Medicare/Medicaid and pay their premiums through the very same Medicare deductions we're already paying, which would be substantially less than the health insurance premiums we are currently having deducted from our paychecks - especially if this option involves, like FICA, employers being required to pay 1/2 the premium amount. In most cases, that would be savings for both the employer and the employee.

I've got 7 more years before I qualify for Medicare, but give me a single shot at buying into Medicare early and replacing the not-really-insurance-of-any-type-bullshit-giveaway-to-private-insurers HSA and the interval required for me to take that shot would be so short that we do not have a mechanism to measure it.