“as (my ultralib friends) keep reminding me, your argument above is also counter to the whole purpose of insurance, the spreading of burdensome costs.”
A lib would say that. In what world is voluntarily entering a scheme whereby you may end up paying for other people’s misfortunes or them yours counter to taking responsibility for your own life? Only an adolescent mind could see no difference between private risk hedging and burden spreading and the State stealing money from Peter to pay for Paul’s cancer.
Here's the problem with that line of reasoning. If Paul's house burns down and he has no fire insurance on it, we would just say, "Too bad for Paul... he should have bought fire insurance."
But if Paul gets cancer and has no health insurance, very few of us would say "Too bad for Paul... I guess he's going to die."
People are not sympathetic with someone who makes a poor financial decision such as fire insurance. But most people are willing to pitch in to save someones life -- in the US they always have been. That is why all of our hospital systems began as charity hospitals.
Our problem for the last 45 years after allowing the government's nose under the tent of health care is that now it has become a massive bureaucracy that cares nothing about Paul's cancer. Paul is just another number to them, not a person who we would extend empathy to. The bureaucracy is incapable of empathy or of caring weather Paul lives or dies. He's just a cypher amidst a mass of paperwork to them.
We have managed to remove the human element of compassion from health care and made it a budgetary matter for faceless, and in fact heartless bureaucracies to handle and often corrupt and greedy 'health care providers' to deliver.
The "charity" and simple human empathy element of health care has been nearly totally removed from the equation. It is now big business thanks to government involvement.