Who should pay?
Who should receive care?
The biggest challenge in the US is 15% of the population earn very little and the top 20% earn a lot. So naturally the bottom are not insured. Public policy was also intentionally kept that way - one who can not afford to buy insurance are left to medicaid or no coverage.
In the US, if you are not a productive member of the society, and you are not rich by inheritance or saving, you deserve to die when sick. Rationing healthcare means medical attention are shifting from the rich to the sick. This is the real reason why there are so many argument against health care reform.
Read WSJ opinion and the message is: If you are poor you deserve to die. Don't expect any help from us.