> So a more efficient system would be one where you selfpay for regular procedures and have insurance for rare, life altering conditions. This is sort of what

> So a more efficient system would be one where you selfpay for regular procedures and have insurance for rare, life altering conditions. This is sort of what a high deductible plan is, which were encouraged by the ACA. After premiums, my first ~$4,000 in medical expenses each year come out of my pocket. Then the next ~4,000 in medical expenses are shared between me and my insurance. Then the remainder is covered by my insurance. The difference is perhaps just what "rare, life altering conditions" means. For a lot of people the cost of medical care becomes untenable not at "oh god I need seven figures in surgeries" but instead "oh god that appendectomy is $50,000 before insurance" or even "oh god I don't have $10,000 to pay for that hospital visit."