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I think something along these lines could work, with one caveat. In the name of true competition, and to turn this concept into something that could be bi-partisan, I would do what Paul says but add an option for people to buy into Medicare as one of the competing groups to choose from. If this were done in a way that the Medicare option premiums reflected the true cost with no subsidies (while benefiting from the efficiencies and buying power that come with something as big as Medicare), then I think both sides of the aisle could support such a system.
The problem with that is that Medicare has a very difficult time attracting enough physicians because the reimbursement rates are so low. Most doctors who accept it subsidize their income with people who pay more than Medicare rates. This is a reality that continually gets ignored by those who offer opening Medicare to all as an option.
So, Medicare already is pretty much stretched about as thin as it can get. If you made "Medicare" another option for everyone under 65, especially with no government subsidies, you'd have a flood of new Medicare patients but very few additional providers willing to work for those rates.
I'm a conservative, but as long as it happens exactly as you say, with the premiums reflecting the true costs without any government subsidies, I'd be willing to accept that as a necessary compromise. Not because I think it would work, but because I'd want to get the rest of what Paul wants through.