> I know I’d rather pay for a Direct Primary Care membership, have catastrophic insurance that covers medical spending above a certain dollar value, and contrib

> I know I’d rather pay for a Direct Primary Care membership, have catastrophic insurance that covers medical spending above a certain dollar value, and contribute to an HSA every year in the meantime while I’m healthy. "Bronze" level insurance is essentially catastrophic insurance. The deductible is so high that you're paying out of pocket for regular care. So the author's desirable scenario already exists. The problem is that even these catastrophic plans cost a significant amount. So much so that it's not really worth it. If you do go to the doctor often you're better off with a higher level of insurance where your premium at least also covers some of your routine care. So it's not that the structure doesn't exist, it's that it's too expensive.