It can't be a hybrid of trying to insure many then with systems like Medicare woven in.  It should either be almost completely private or a single payer health system.  Single payer works in some countries whose citizens are more responsible about their health and don't expect everything.  Not sure that would be efficient here.

At minimum, something should clamp down on these rising costs, but neither Dems or Repubs ever dare bring that up.

Maybe a single payer for all on routine medical, with the individual paying procedures above and beyond through the private insurance system or HSA's.  Is that what Paul's proposing?