Potential Administrative cost savings of $90 billion I pointed to are on the LOW side. Overall US health care Administrative costs today are reported to be 31% of total annual costs of say, the $2.4trillion you mention. This amounts to $744 billion in annual Administrative costs.
So my $90 billion cost saving estimate represents a meager 12% cost reduction ... however, still enough to cover the entire expected added cost of $75 billion to insure the uninsured and inadequately insured.
As to what the best system solution is, I'm in no position to say what the best Model mix for the Hodgepoge system MESS described bluntly but truthfully by John and me. The Netherlands has "reinjected market forces" as you propose into its unique managed competition health care program. But it's a simple as well as very sophisticated system where the GP has a key role as the Gatekeeper to insure no overuse of sppecialist care
At the moment, I do favor some CENTRAL and DECENTRALIZED Single Payer program perhaps offered by Medicare as well as private insurers (to maximize competition).
Whatever the final decisions here by Obama's Administration, I believe the final Real Reforms for a BASIC CARE quality-cost effective system should reflect some of the following KEY elements introduced step-by-step as needed:
A....Care based on need, not ability to pay
B....Care based on a reasonably uniform, standard health care benefits package for all
C....Care based on simplifying, harmonizing and coordinating federal and state health care including standarization and computerization of medical treatment coding, billing forms, and billing procedures
D....Care based on NO pre-conditions or risk rationing of clients by insurers
E....Care based preferably on NO deductibles/co-pays for incomes below say, 150% of the poverty level or $30,000, and perhaps income-means graduated deductibles/co-pays beyond this level
F....Care where the insured or to be insured always have free choice of insurers and providers
G....Care based on premium costs deductibles and co-pays preferably being no more than 5-6% of one's income above $30,000 with balance of funding coming from employers and employees through possibly a shared federal/state payroll tax of say, 6% sent directly. This is part of attempt to get at harmonization of 50 state different rules and taxes regarding health care.
H.... Care system that provides uniform high quality standards and tight oversight of same regionally and locally particularly; individual state income and/or tax-base wealth differences would be subsidized by federal government
I....Supplemental insurance coverage by private insurers enriched coverages, for catastrophic or long-lasting chronic illnesses.
The insurer industry also needs extensive Consolidation to reach appropriate health care economies of scale regionally.