Even in the most idealized system you need some kind of insurance, siply because the risks are so variable, so high, and so unknowable between individuals, between stages of life, between regions and populations. People often argue, gee, why don’t we have some kind of social insurance for food, say, or housing, since you really need them to live. Yes, but: The amount of food you need (and your family needs) to survive is knowable and stable. So is housing, within a range. Healthcare needs are more as if you didn’t need any food for years, and suddenly without real warning you need food on a regular basis, and then somebody jacks the price of food up to $1000 a day. Even if healthcare cost only 20% of what it does now, simply paying for all of it out of our own pockets on demand would still put all of us but billionaires at constant risk of bankruptcy.