Health insurance companies rake in around 16% of the economy and rising. It is not sustainable. The reason the US has medicare, medicaid and VA in the first place is because these groups are either high risk or poor, rejected by insurance companies. Now many middle class are joining the ranks of the uninsurable as the elderly, disabled and poor from years back. The only way a new system will work is not to segment people into multiple groups but to mix low risk with those that are high risk, a one payer system, the ultimate large group. All should contribute in some way or the other, any other way will fail in time. For those who make the argument against this and at the same time praise medicare and the VA infact make my point. Also, a one payer will stimulate businesses across this nation, and will eliminate redundant government agencies. I do believe the wealthy can not opt out and private insurance should be available to those who choose it.