However, it's a bit of a sticky, dividing part for a lot of libertarians - especially the more dedicated believers. You get the ones that are just so driven to "gub'mint don't tread on me!", and you get the ones that understand that any mindset or belief is not bulletproof in theory and/or in practice and need to build safeguards in place.
In an ideal, perfect world to a lot of libertarians (again, this is subjective) - there wouldn't be a need for any government ran programs. That will never, EVER happen in my opinion. There will always still be people who just are not educated, intelligent, lucky, skillful, advantageous (whatever qualifier anyone picks to use) enough to succeed or to be able to have an acceptable standard of living independently. We need to have some sort of safety net in place. What that net is, I'm not educated enough to offer an opinion or thoughts on specifically.
Rest assured that there's a LOT of libertarians that understand that "shit happens" and there should be systems in place to handle these edge cases.
As I've commented before, people regularly oversimplify this problem as socialized vs private healthcare without considering why American healthcare is so broken. If you look carefully at the problems, you see that they won't go away if the government replaces private insurance and expands Medicare for everyone. These problems include a tremendous shortage of doctors [0]. Even Canada and the UK have more doctors per capita, and they are known for extremely high wait times (the jokes of the socialized medicine countries, so to speak). There are a number of possible reasons for this, most notably the hassle of occupational licensing (12-14 years of expensive college + 'indentured servitude' residency in the US).
Nonetheless, American healthcare science is still ahead of the curve and subsidizes socialized countries -- ~60% of all new drugs between 2001-2010 were invented in the US, and foreign dignitaries of socialized medicine countries often still get important procedures done in the US [1]. It would be interesting to see how the R&D dynamic plays out if America loses its market incentive to innovate in the space, and no other developed countries have the financial incentive left.
[0] https://data.worldbank.org/indicator/SH.MED.PHYS.ZS?end=2018....
[1] https://xconomy.com/seattle/2014/09/02/which-countries-excel....
1. I would like to see the spending the government currently does regarding healthcare (govt employees, elected officials, medicare, medicaid, va, etc) rolled into a non-profit healthcare corporation. It's important to include the government officials and staffing here, as they get the same as everyone else to discourage tiered services.
2. From there, I would make it a requirement that Insurance Corporations act and negotiate as a fiduciary on behalf of their clients. One of the serious lapses in the Obamacare legislation that has let insurance companies largely not try to negotiate prices down in order to raise the oceans in terms of costs/profits.
3. I would seriously reform/eliminate extension patents. (competition)
4. I would make dual-sourcing a licensing requirement from the FDA. (security + competition)
5. I would make 50% US production for all medications a requirement for FDA approved use (security).
6. Any company can purchase coverage policies from the Non-profit insurance corp that covers govt employees and current welfare coverage programs.
7. Require no more than a 20% pricing variance between customers in a 15 month window for a given procedure by a medical provider. (no dual-books for insurance covered and private pay)
While there are other steps that can be done... part of it is to merge and adjust spending directly based on current spending, but having a non-profit corp that also covers govt employees is a baseline. By breaking it off, you can allow for a stronger level of competition of services.
Reducing patent protections, and making dual sourcing and partial domestic production requirements you again encourage competition. The requirement for dual-sourcing is partly security and partly to ensure competition.
Now, this is emphatically not a Libertarian ideal, and would not cover everyone, but what it would do is expand competition and reduce incentives for poor behavior. It should have the side effect of lowered costs over time. From there, individual states could create their own expansions or services beyond this, as could specific cities.
Over time, I'd prefer to see the FDA shrunk and sane guidelines in their place... Allowing for input based on relatively trusted testing to allow/disallow certain medications and reduce the incentives to produce less-good drugs only to expand patent exclusivity.
It would take a groundswell of support for such actions.
I now believe that the best way to reduce government corruption is to reduce government. I also feel that government support for corporations should also be limited, and corporations should be carved out as a "non-living entity" class separate from personhood.
I'm more pragmatic that the more an-cap side of things, I feel that the government should at least orchestrate essential infrastructure, and that should include internet, telecom and roads/highways. Most of that PoV is rooted in domestic security.