A thought for anyone who may have some insight to this issue.
In Idaho we had options for work comp insurance. We could buy insurance from our private insurance company or from the state operated workmans comp program.

On the years our industry had few or no claims as an employer paying into the state insurance fund we would recieve a refund. In years that claims were higher the rates may go higher or refunds were less.

It would seem that comparable programs like this for medical care could be operated on this type of scale to help the uninsured that cannot afford insurance or for employers with small enterprises that would like to create health plans for their employees.

The options were available for private or state insurance. So a choice was given.