The macro issue is that uninsured and underinsured people (who need care) are paid for by the rest of us one way or another (or we become a place where sick poor people literally die on the street).

The old way was the ER option — make the hospitals pay for it (through “can’t refuse” mandates) — which the hospitals then have to fund via fees they charge paying customers (mostly employers and government in the past — and not actually insurance companies surprisingly before the ACA). The ER option sucks for everyone involved. Diagnosing and treating colds at $500-$5000 per patient is insane (hospitals often had to re-diagnose all existing conditions before treating any symptoms!!!). Clinics and similar charity alternatives are awesome, but never approached the scale to make a real economic dent (and it isn’t really fair or logical to ask doctors to do their job on a regular voluntary basis in the wealthiest country in history).

This idea of continuous coverage sounds fine until you walk through the “edge” scenarios — where people who can’t or choose not buy coverage need care. Personal responsibility sounds great until someone needs $250k worth of care to survive or needs a $1500/month drug, etc.

Healthcare isn’t like pre-paying for gas at the rental counter or paying $7/gal when you return the car. The tail of the cost curve is way, way, way too long. It would be like pre-paying at $5/gal or paying $10,000/gal if you don’t and forget to fill it up (or the local gas station happens to be out of gas when you need it).

Thanks for your intelligent analysis.