The difference -- and don't even pretend you don't understand this -- is that subsistence food and housing can be paid for by someone earning relatively little money. Even a penniless, homeless person can survive in shelters and soup kitchens. But the costs of health care are literally unlimited.
So really, the key is determining what the functional equivalent of "shelters and soup kitchens" is in healthcare.
Premiums on the Iowa exchange just went up because one patient with a severe chronic illness is costing $1 million a month.
That brings up the next couple of questions: Why does that condition cost so much? Should a healthcare system be expected to meet every need of every citizen regardless of how much it costs?
And someone who can't afford basic preventive care is likely to put off treatment until he lands in an emergency room, where he gets uncompensated care paid for by everybody else.
If they are poor, I agree that we should reform Medicaid to cover anyone in poverty; Medicaid is too limited right now. If they aren't poor, then what do you mean "can't afford basic preventative care?" If you have no insurance, a yearly preventive visit will run you somewhere around $150. After that, the best prevention is extremely low cost: diet and activity modifications, don't smoke or drink, don't engage in risky behaviors, etc. Do that, and your risks of chronic illness are much lower.
What is your objection to the basic premise of insurance? Everyone needs health care, if not this week or even this year, then sooner or later, and if you're unlucky you'll need treatment for cancer or heart disease or getting run over by a bus. Sharing costs across the widest base is the only way to guarantee that everyone will get the care he needs when he needs it.
I have no objection to the basic premise of insurance. The key word is "insurance." Insurance plans should insure against catastrophe. We shouldn't demand that it covers routine costs that are more efficiently delivered through a cash based model.
If you want to argue that health care is a luxury good, and someone who can't afford it doesn't deserve it, you won't find much support outside the Freedom Caucus, and even they are starting to smarten up.
That's not my position at all. Insurance will be affordable when we stop expecting it to cover every possible medical expense we will have. So for most things, you pay healthcare providers directly in cash. The insurance plan will kick in if and when spending exceeds a certain level. Even then, however, it's unrealistic to expect insurance to cover unlimited expenses.
