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It's true that almost all people in developed countries eventually get old and frail, but it's not like people want to have health insurance so that it keeps them from getting old and frail. I imagine most sensible people who want it do so because they want insurance that they don't die from curable diseases that aren't their own fault. Theoretically there should be room for insurance of this sort.
This got nuked when it became illegal to deny people for preexisting conditions. It's doubly fucked when something like half all all chronic conditions can be traced to poor lifestyle management; diet, exercise, and substance misuse/abuse both legal and otherwise.
To extend the "most ships don't sink, most mail doesn't get lost" metaphor; most people want to drive their cars forever without hitting anyone or being hit by anyone. People who drink too much, smoke, don't exercise, and eat pseudo-food might not desire to see the doctor in a philosophical sense, but they're loudly ignoring the reality that they will need to in short order. It's the equivalent of driving blindfolded with your feet and, after hitting a lightpost, proclaiming, "_of course I didn't want to do that!"
In the west, we're actually pretty good at solving the big problems of actual healthcare (not health insurance) through good old fashioned innovation and market incentives. Diabetes used to mean losing a foot, and insulin changed that. Antibiotics going back to penicillin mean that you can literally get your can now body cavity opened up in ways that, in yesteryear, would've been a slow and agonizing death by infection. I contend that the greatest medicinal invention ever was functional public sewage and waste disposal paired with ubiquitous flush toilets and showers.
We're very bad at dealing with repeated objectively horrible decision making at the individual level. This is the thread that ties together not only healthcare but also welfare, criminal punishment, and abortion (to name the a few off the top of my head). If a given person wants to keep making awful decision, a free society has to tolerate that to some extent. The alternative is tyranny. What a free society should not do, in my opinion, and cannot do perpetually, is actively subsidize these bad decisions and/or the consequences arising from them.
There's a mechanism that's good at that; call it the "invisible iron fist". But we do our best to prevent it from operating.
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Yeah but the issue with the current healthcare meta is that a huge amount of spending is then absorbed fighting over the last hitpoints of people with cancer that can be delayed but not really cured along with other chronic old age issues. Sudden deaths from Strokes/Heart Attacks are down due to improved diets and better practice, meaning more and more people are dying in the midst of prolonged arm wrestles with chronic conditions at great expense.
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One option could be to have a ‘premium’ package on a critical care / serious illness model for working age people where they get access to priority care, better hospitals and treatment if, say, aged 18 to 65 and seriously ill, and then a standard package for people above and below that age paid for by the state.
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