To do this subject justice would require more work than I'm willing to do for free, but I think a means-tested program of vouchers for medical care might work. As far as I know, the Food Stamp program, a similar concept, has been successful, has not been turned into a "universal" food supplement program, and has not suffered a great deal of "benefit creep" in the last decades.

Think of vouchers that would be good for a certain amount of "free" medical care: doctor visits, emergency room visits, surgery, etc. How this would be parceled out--checkups at one end of the spectrum, cardiac surgery at the other end--would take a lot of thinking. Real problems only: you want your boobs enlarged, you're on your own.

After you use up your vouchers, a copayment starts to figure into it. Start low, slowly raise them.

You MUST have some kind of connection to the patient's wallet at some point, even a poor patient, or positive feedback starts to come into it.

If it worked, and you made the elderly eligible, you might have a shot at eventually converting the current "universal elderly insurance" program into something that deals only with those who really need it, and start feeding the well-off elderly back into the private insurance system. And maybe the massive Medicare debt bearing down on us could be eased up a bit.