I think the biggest complicating factor is that everything you just said is true, but health insurance is also still sometimes insurance, as well as redistribut

I think the biggest complicating factor is that everything you just said is true, but health insurance is also still sometimes insurance, as well as redistribution. So it's doing three things at once: - Paying for routine care for people who could otherwise afford it. - Paying for unexpected and unaffordable care, like chemotherapy. - Paying for routine care for people who can't afford it. Note that the third category doesn't refer only to poor people. Routine childbirth costs thousands of dollars. Any reforms targeted at the first category of spending, which hurt people in the second and third categories, are politically unacceptable. Add to that another complication: - Unexpected/catastrophic medical expenses and routine care are closely related, especially in the long tail of expensive patients. For example, the number of emergency room visits a patient makes (especially very expensive patients who make a lot of visits) is lower if the patient is making regular doctor's appointments and following their doctor's orders. But when regular care and monitoring come out of the patient's pocket, and emergency room visits don't, the incentives are horrible. So these are extremely difficult political and business issues that health insurance has, which e.g. auto insurance doesn't. Most of the solutions to one of these problems, will have negative side effects for the others.