In most political philosophies, one of the main purposes of government is to tackle collective action/free rider problems. You're forced to subsidize everyone's

In most political philosophies, one of the main purposes of government is to tackle collective action/free rider problems. You're forced to subsidize everyone's education because although it's rational to subsidize it up to a point, if you can continue to accrue the benefits without paying, then why do so? So everyone benefits from better education, but after a certain point any individual is better off not paying into it, which breaks the system if you lack consequences. This is even more of an issue for healthcare than education, since people have wildly differing costs, and the mix of things you can control (healthy living) and things you can't (genetics) make it clash with lots of Americans' underlying political ideals. In stark economic theory, health care would be very simple if we just let people who couldn't afford it die, because then nobody would bear the costs of catastrophic care. We as a society (thankfully!) don't do that, so we end up paying for it anyway when a poor person goes into the ER. Given the baseline that you don't let people die who can be saved, it's a short jump to a collective action problem, especially given the wildly varying income inequality and the fact that health care is demand inelastic and price insensitive (you'll pay any amount of money to not die, and for the foreseeable future people will always get sick/injured). I'd argue that it's better to internalize those costs - Insured people are cheaper overall, so everyone gets insurance and it gets subsidized by everyone, with transparent-ish rates, than externalize them (the hospital has to cover the un-negotiated costs of a poor cancer patient, so tylenol is now $17/pill) [1] https://en.wikipedia.org/wiki/Free_rider_problem https://en.wikipedia.org/wiki/Free_rider_problem