[wdfifteen]

I have thought long and hard about a workable, fair, and constitutionally compliant health care system. This is what I think.

We need a universal, government run system that you can opt out of if you choose. If you opt in you pay premiums to the government and get the benefits of a fully paid health insurance plan including emergency room care. If you opt out and choose to go it alone, you don't pay a premium to the government. Your health care is totally between you and the provider. ERs are no longer required to treat you, government doesn't force doctors to do anything they don't want to do. Every year as part of your tax form you explicitly choose to opt in or out for that year.
If you opt in when you are 20 your premiums begin low - $500 or so a year, and rise slowly every year until you are, say 65 at which time they are level. If you opt in at 30 your premiums start at 2 to 3 times that of a person who opted in at 20. At 40 they are 10 times. By the age of 50, if you have never had health insurance, the cost of a government policy would be astronomical, but it's been your choice all along. Go get private insurance. At 65 forget it - if you aren't in the government system you will have to go with a private insurer. If you hit hard times and can't buy insurance for a year, you get credit for the years you did pay (unlike current private insurers). All along you have the opportunity to use a free market solution or a government one.
There will be rationing in the government system. If you don't want your health care rationed you can buy private insurance. Or you can buy private insurance to cover what the government program won't - like say a heart transplant at the age of 70.
It would be great if a private insurer would start such a system and play the role of the government. We wouldn't need a government system at all.