Ayn Rand novel. I used to think more like that (although not quite that extreme). I'm guessing you're a good bit younger than me.

Your system is just not realistic at all. It's not realistic to assume that people in a totally free market health care system without government involvement are going to buy health insurance. Hell, 1 in 5 drivers in Florida don't have auto insurance and that's something that is mandated by law... not just something that comes with a bad consequence if you don't have it when needed (it comes with that too). It is also far less expensive than health insurance (even while acknowledging it would be less expensive in your proposed system) and yet 1 in 5 people say... "nope, not gonna pay for that".

So we could say "fuck 'em" to the people who don't buy insurance, but that's going to lead to chaos and be really bad for society when a substantial portion of the country can't afford necessary healthcare even through their own fault. It's also going to involve a ton of kids whose parents don't by insurance. We going to say "fuck 'em" to the kids too?

As far as very few people having a preexisting condition? You going to mandate that companies can't drop a high risk insured? Because if they could, once someone gets cancer, no company is going to touch them moving forward. So even if the insurance company paid for the treatment of the initial occurrence (and this is assuming the policy is not written by the insurer to protect their financial losses and limit their out of pocket on the initial occurrence), they're going to cancel the high risk insured moving forward because people who develop cancer are statistically more likely to a) have a recurrence b) develop a totally unrelated other type of cancer. All other free market insurers drop high risk insureds all the time. Does your system have such restrictions in dropping coverage in place (i.e. NOT totally free market)