I'm Confused: Health Care

OK, I've been puzzling over the health care plans put forth by Clinton and Obama (and Edwards, not that it matters anymore).  I've read them.  I've read commentaries on them.  And there are still some things I don't get.

How are these requirements that insurance suddenly become universal (in that no one can be denied on the basis of preexisting conditions and so forth) and also affordable supposed to work?  I mean, as far as I can tell, both plans are still working through mostly private insurers--that is, insurance companies that exist to make profit.  I think that a) the insurance companies are going to put up one hell of a fight about that and b) Congress and the courts won't go for it anyway, because requiring companies to do this sort of thing seems like a government intrusion into business that no one will actually approve.

Also, how exactly are we going to mandate (Clinton does; Obama not, apparently) that everyone buy insurance of some kind without also having pretty far-reaching solutions for the growing lower classes?  I understand Clinton wants to mandate that everyone buy insurance but at the same time index the premiums to income--but we're talking mostly about families who are already stretched to the breaking point.  Real wages haven't gone up in my lifetime; we're losing jobs; we're in a bloody recession!  There are already plenty of us who can technically afford health insurance but still cannot actually afford to go to the doctor for simple things like strep throat*.  I don't see this helping that situation, although they claim that they are going to reduce health-care costs at the same time.  But it is not at all clear to me how exactly this is supposed to happen. 

I understand this has been compared to requiring car insurance, which we already do.  Except that there are actually a lot of people out there who flout that mandate because they either cannot afford or cannot get car insurance.  You can require people to do things that they still do not do--I know this well, as I have a 2-year-old in my house.  Paul Krugman is arguing that Clinton's plan, by mandating that all the poor schleps out there further stretch their budget by buying some kind of health insurance, will get us universal health care.  Mmmm, I doubt it.  It will likely get nearly everyone to be insured, yes, but if they still can't afford to go to the doctor when they need to, I don't think it's much of a victory.

I thought--silly me--that the idea behind universal health care was that all people would be covered and be able to afford to actually use the services of health care providers.  Unless Clinton and/or Obama suddenly comes up with radical plans to greatly reduce the already plentiful economic burdens on those of us who exist between the median income and the poverty line, I really don't see this helping very much. 

Am I too pessimistic, or am I missing some key part of their plans?  O wise readers, please tell me it's one or the other (or both) because otherwise, this poo just stinks.

*Last year, we (my family) were in this position.  This year we're a little better off.  The main difference is not that we have more money but that T's employer offers flexible spending accounts (which Hillary does not approve of, or so I hear) that allow us to deposit a portion of each of his paychecks into a special account we can use for medical expenses.  You get a tax break by doing this, but the tax break doesn't actually save us any money because our tax bracket is already a negative percent.  All it does for us is ensures that there is money for medical expenses.  We don't miss the $34 or whatever per paycheck, and then the money is there when we need it.  However, we don't miss that money mostly because we are excessively, obsessively frugal, and I believe a lot of families in our income bracket would miss it.