in a purely free market system, but there’s no way that open heart surgery, or chemotherapy, radiation, immunotherapy, etc is not way beyond the means of everyone but the top fractional percentage of the population. And so that’s where insurance comes in, but even in a far more efficient system, the underlying cost of health care is expensive and so insurance is going to be expensive. And so some people are going to a) legitimately be unable to afford the premiums, b) roll the dice and go uninsured, because of the cost of premiums and c) lose coverage due to a condition that makes them uninsurable. I guess with “b” you can say “tough shit”, but again, are hospitals going to turn away an uninsured auto accident victim? If not, then those costs have to get absorbed elsewhere which just makes problem “a” worse. And problem c…? I don’t want to live in a country where we tell people who lose coverage due to a preexisting condition “tough shit”.

Also in a purely free market insurance system, health insurance will be based on similar risk pools and will be really cheap for the young and healthy and by the time you’re in your 60s, it will be completely unaffordable. Similar to life insurance. Outside of estate planning reasons, no one in their 60s buys life insurance. The premiums make it cost prohibitive to do so. The private market would likely offer “long term health insurance” plans, similar to long term care insurance, but in reality, how many people in their 20s and 30s are going to pay multiple $10s of thousands of dollars per year in premiums for 30-40 years to ensure they’re covered as seniors. It’s pure fantasy to think that happens.