Even the great economic minds who advocated free markets admitted they have limits. Healthcare is one of the things that does not work in a free market, in part because it is simply way too expensive finance out-of-pocket for the vast majority. There are other more arcane reasons, but we don't even need to go there.
That is why we have a third party funding vehicle called health insurance. I could go through the whole fuvking history, but we don't have time. Third party itself create some anti-market issues; which become an excuse for large deductibles and copay; which are really designed to discourage "overuse" of healthcare. You jerks over use routine healthcare unless you have to pay out of pocket!
The bigger problem with using insurance to finance healthcare is insurance is intended to finance risks, not needs. That is why catastrophic health insurance makes more financial sense.
Left to operate in a free market, insurers try to limit risk exposure. They deny coverage, add exclusion riders, charge extra premium, close pools, or cancel policies to avoid to covering people they deem uninsurable. This keeps their rates low and profits high.
The problem is this defeats the social purpose of having health insurance, since those who need it the most do not have it.
So state and federal governments come up with a hodgepodge of often redundant, contradictory, confusing, expensive regulations and subsidies to try and somehow make health insurance work.
It was probably close to 30 years ago some major insurance companies quietly assembled a work group of brokers, agents, and underwriters to figure out how to fix the mess. They had two ideas:
1. Tweak Medicare and expand it to cover everyone. Medicare for All. National health insurance.
2. Mandatory private health insurance with tax credit subsidies and tax penalty incentives. Obamacare went this direction.
I gather nationalized healthcare was not seriously considered. I don't think there was any enthusiasm to privatize Medicare either. From what I recall agents were skeptical about flex spending and msa / has type plans.I liked the concepts of msa / hsa plans back then, basically buy catastrophic and invest the difference.
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