Exactly: the incentives are wrong for everyone under an insurance model. Healthier people have an incentive to leave the risk pool and/or only keep catastrophi

Exactly: the incentives are wrong for everyone under an insurance model. Healthier people have an incentive to leave the risk pool and/or only keep catastrophic coverage, increasing premiums for everyone less fortunate. Insurance companies have no incentive to insure anyone who seems like a high risk, i.e. due to a pre-existing or likely-to-emerge condition. Consumers have no incentive to manage their own care expenses or make decisions for themselves, because if they have insurance they're not really paying the full costs. Insurance companies have incentives to deny care whenever possible. Hospitals and doctors have an incentive to charge uninsured people more than insurance companies so that the insurance companies can provide a value-add and because they have to make up for all the care provided to un-/underinsured people who can't pay their bills. If you believe that a wealthy society like ours has a moral imperative to take care of its poor and sick and elderly, then the insurance model is hopelessly broken. It doesn't mean there's some perfect model out there that has perfectly aligned incentives and no moral hazard, just that this one is probably one of the worse ways to organize things. If you don't believe that there's any such moral imperative, then that's an entirely different debate.