If you actually want insurance, then that is exactly the right way to phrase it. The purpose of insurance is to provide me a way to pay for disasters that I ot

If you actually want insurance, then that is exactly the right way to phrase it. The purpose of insurance is to provide me a way to pay for disasters that I otherwise could not afford. To that end I make payments that, on average, leave me poorer. But since I can afford the payments and can't afford the disaster, it leaves my expected quality of life better off by reducing the variance in my expected outcomes. When I am paying a premium to pay for normal things that I can actually afford, that is not serving as insurance. It is now just a bad deal for me, pay extra for a middleman that I have no reason to want. I may not want that middleman, but health care insurance companies want to be one. They therefore want me to pay a premium to them for things that I could have afforded, and not cover things that I couldn't afford. To that end they work to construct deals with employers+government so that employees don't have a viable alternative to entering this deal no matter what my opinion is. This would give them a large amount of business with a guaranteed profit margin. And leaves me uninsured exactly when I would have wanted to be insured. I understand exactly why they want to be in that line of business. But none of the rest of us should support that. Incidentally, while we are at it, the ACA has a really bad perverse incentive. As you say, 80% of premiums have to go to medical care. Which means that if health care providers charge more, then "insurance" companies are allowed to profit more. Now look at this from the point of the insurance company's CEOs. As long as they can predict the growth in medical expenses, growing medical expenses are good for their bottom line. Where then the incentive for cost savings? Better yet, if they know that some of those medical expenses are fraudulent and can readily expose it, they can always keep their predictions of expenses in line with the reality by exposing just enough fraud to make their predictions accurate. This is an incentive to turn a temporary blind eye to fraud. And so the ongoing explosion of medical expenses is good for insurance companies.