What Do We Want out of a Gov't Healthcare Initiative?

Obama vowed today to promote improvements in the healthcare system.

There are three reasons I know of for the government to get involved in healthcare. Here there are from best to worst, according to my humble opinion:

• Transfer of money to the poor – If you want to help the poor, one way to do it is to subsidize their healthcare. This discourages them from waiting till a health problem becomes severe before seeking treatment. It's better way to transfer value to the poor than simply giving them money, which could be put to bad uses.
• Spreading the risk – We have expensive technologies to treat illnesses of those who lost the genetic lottery of health and sickness. Some people think it’s fair to spread the risk of being born with serious illnesses or predisposition to illness by spreading the cost among all healthcare consumers. Insurance currently does this job, but it will be harder as medical technologies get better at predicting who will get sick long before it happens. If genetic testing gets very good at predicting infants’ future adult illnesses, insurance won’t be able to spread that risk. We will need a gov’t system, if we want that risk spread out.
• Managing middle-class people’s lives – Many people with decent income don’t like to manage their health insurance. They can handle their car/life/disability/home owners’ insurance, but they're loath to shop among health insurance providers, select one, and write them checks. They want someone else to deal with this. (IMHO government is doing them a grave disservice by offering to manage otherwise competent people’s lives for them.)

Any program needs to be clear on to what extent it’s trying to accomplish each of these. The job will be hard because so many people disagree. Ideologically, I like transferring money to the poor; I believe in gov’t spreading risk as necessary; and I think managing middle-class lives is a disgrace to American values. People of good conscience disagree.

This issue will be tough sledding because the problem is difficult and the solution touches ideological issues regarding the role of government. Obama has his work cut out for him.