Coverage for the 49 million uninsured? Impossible?
What about this? No direct penalty on a person who doesn't sign up for health insurance. But, when a person shows up at a health care provider with no coverage, he can either pay up front out of pocket or enroll in a government-sponsored insurance program whereby a surcharge is added to his federal payroll tax. If he (or she) has family members who need coverage, the surcharge would be a bit higher. This way coverage costs are reduced by the beneficiaries, and yet, the system is fair because surcharges are pro-rated.
Such an enrollee would later have the option of shifting from this plan to some other private plan.
This idea would mean that the large number who don't choose to sign up right away won't be depleting the Treasury in a big surge. On the other hand, the uninsured -- and greviously underinsured -- would help to pay their way in a manner that will work: a payroll tax surcharge.
If a moderate tax surcharge -- only on those who enroll -- gives people decent coverage, it is unlikely they will complain much.
Curious coincidence: Before David Axelrod sent out a chain email on health care, none of my email with the .gov tail was ending up in the Gmail spam box. But then certain people accused Axelrod of spamming, and, voila, Google's program seems to morph to redirect the White House emails into the no-read box. Also, my spam icon stopped working properly.