Or if it is there then have it based on ability to pay.

And limit it to copay, not something like 80% insurance/20% co-insurance (which means out of pocket.)

A $30 copay isn't a joke to someone who is making $8.50 an hour.
A 20% patient portion of a $400 bill ain't a joke either.

We should be sharing the cost across ALL Americans - not just ones within a certain insurance group.

Right now we have something like 25 million American's without medical coverage at all (going to a possible 45 million if Trumpcare were to pass) - I don't think focusing in on "I have insurance and it should cost more and I should really want to use it before I do" is the wrong thing to focus on.

And the second we do talk about preventing abuse - like how to prevent people from abusing it - well we're off into Death panel territory.