Also, does your plan also allow you to go to any provider for care if you're under your deductible and so are paying out of pocket? If not, you can't shop around even though you are paying the cost. That means you don't really have any market power.

> So what’s the actual proposal here?

I wasn't making a proposal, just highlighting a serious deficiency of the current system. However, the proposal would be obvious: separate out the three kinds of conditions I described and handle them separately.

For emergency care, you would buy insurance, which would work like any other kind of insurance against unanticipated large expenses.

For ordinary predictable expenses and unpredictable but manageable expenses, you would pay out of pocket, just like you pay out of pocket for other ordinary predictable expenses, like food, and other unpredictable but manageable expenses, like household repairs. In other words, it would be just like any other market. And like any other market, there would probably be businesses trying to sell "care plans" where you pay a fixed amount per month and get comprehensive coverage, much like existing plans (and like the extended care plans that car dealers will offer you when you buy a car). But it would be your choice whether to buy them or not, based on your particular circumstances and attitude towards risk.

In such a market there would also be an obvious business opportunity for plans insuring against non-emergency but chronic conditions like cancer. There would also be incentives to widen the risk pool. If there is a place where the power of the government could be used usefully, it would be here: treat all citizens as a single risk pool and negotiate with insurers for coverage of just these conditions based on actuarial data over the entire population. But I'm not optimistic that it would be politically possible to limit the government's involvement to just that.