The first part is to go back and think about the puzzle of why we have Medicare and Medicaid in the crazy way we do. It defies logic, and as my grandmother would have said, "what is this meshuga'as (craziness)"? You have Medicare Part A, which is a trust fund based upon payroll tax, and if you are over 65, then you are in. Part B is an insurance model, where the beneficiary pays some premium and it is therefore voluntary. Both are administered and financed exclusively by the federal government with uniform eligibility, requirements and benefits.
"Symposium Keynote Speeches: Opening Remarks,"
Yale Journal of Health Policy, Law, and Ethics: Vol. 15
, Article 3.
Available at: https://digitalcommons.law.yale.edu/yjhple/vol15/iss1/3