Universal insurance general questions and ideas

[i_am_not_john_galt]

Just a couple of broad philosophical question that seems to be at the core of why we can't get this going:

With the advances in every branch of medicine, virtually everyone will probably use more, and more expensive, medical services than before. A few decades ago lots of people just lived with medical problems (or died from them) for which we now have treatments - everything from chronic heartburn to impotence to congenital heart defects. And as we grow older (esp. us baby boomers) the need and desire for advanced medical treatments will grow exponentially. At some point isn't this unsustainable? How would universal health care plans handle this triage? Would the wealthy always be able to pay out-of-pocket for their needs? Wouldn't health care providers migrate to the wealthy cash-based system, impovershing the public health system?

Should plans make some distinction between maladies which result from choices (like my consumption of donuts) and those which don't? Should a person who makes healthy choices subsidize the consequences of those who don't?

And an idea:
What if health insurance was uncoupled from employment and instead grouping (the basis of the insurance business) was based at the state level? Any company that wanted to offer health insurance would have to do so at universal rates for an entire state. Presumably multiple companies would offer a variety of insurance plans, paid for individually (maybe with a subsidy or tax credit for the poor), and individuals could choose among them. That way freedom of choice would be preserved for all, states would benefit from efforts to contain medical costs and increase healthy lifestyles, and every individual would have the same access to coverage. This seems like an attainable reform - one that people could understand and that doesn't threaten what people like about their insurance.