This, I believe, was the point that Rush Limbaugh was trying to make on Thursday that we shouldn't call this insurance. In a sense, our healthcare problem is unsolvable with the idea of insurance as simple risk management. Allowances are going have to be made for those with preexisting conditions, particularly those which are not caused by their behaviors. To some degree, many people are going to pay more than their individual cost to cover the uninsured and the uninsurable.
And Medicaid underpayment.
But that's already the case:
To the former, bad debt and charity care are the biggest cost drivers in provider charges. Of course they pass this on to the carriers and cash customers unless they object. (cost shifting)
Regarding uninsurables, if done properly through a wide-disperal assessment, it should cost each premium very little.