through single payer or through efficiencies. That has to be addressed at the root cause.

With respect to the general cost of ER visits...
a) I think if everyone had coverage, some of the ER visits should go away (my understanding is people without insurance who need to see a doctor will sometimes go to the ER because they know they will not be turned away)
b) My plan WOULD still have elements of catastrophic coverage. Everyone would have basic coverage with minimal reimbursement rates. Those reimbursement rates would likely not be accepted for most ER visits, so If you go to the ER you will get a supplemental bill that you would be on the hook for up until some max out of pocket amount. For the truly poor, hospitals would just have to write that amount off. For others, I think it could cause people to scrutinize wether a trip to the ER is really warranted (I realize this is a double edge sword). Maybe I'm solving for an anecdotal problem, but we have good friends with 2 kids the same age as mine (10 & 11). We have known them for 11 years. In the time we've known them, I bet they've had 20 plus ER visits between the 4 of them (and I'm more likely to be understating than overstating this). None of them turned out to be serious. Over that same period of time, my family of 4 has had 3 ER visits (and 2 were for me and required extended hospitalization... so there was no gray area as to whether I actually needed to go to the ER). ER's probably need to be better at triaging and sending people home who really don't need emergency care (without a 5 figure bill). And people who overreact and go to the ER for minor symptoms need to be discouraged from doing so. A non-trivial out of pocket charge might do that.

Prescription drugs would work the same way, but we'd probably need to introduce some means tested assistance for people who truly can't afford the provider "up charge".