Well, in this current system everyone (excepting those who choose to opt out and pay a fine instead) receives a basic level of coverage - it's definitely not perfect and it has issues, I'm not going to argue against that. In the 90s and early 2000s it was much easier to bankrupt yourself due to extremely unlucky life events - but if insurance was prohibited you'd be unable to access care so instead of losing your house you'd lose your life.

I think I laid that out pretty clearly in the prior comment, is there some part of it that's unclear?

People without insurance used to get care and then go bankrupt. Today people without insurance still get care and then go bankrupt. What I’m not understanding is why people in this theoretical future without insurance wouldn’t do the same thing?

I feel like we’re talking past each other. Sorry if I’m being dense.

The blanket statement "people without insurance used to get care and then go bankrupt" does not apply to every single instance. Sometimes people were (and are) already so close to bankruptcy that they simply cannot afford the care that they need, so "I'll get health care and then go bankrupt" is not a live option for them.

Yes, emergency care has been essentially free in the US for those who can never pay for it, but that doesn't cover, say, chemotherapy. If you don't have insurance and don't have any way to generate significant cash (no house to sell and no wealthy generous friends) it's not that you're going to get chemo and it'll bankrupt you; you just won't get chemo at all (and you'll probably die). This is a little better now with the medicaid expansion, but not perfect, and not all states expanded medicaid.

Even today we have people dying of complications related to diabetes -- a serious but very treatable affliction -- because they can't afford supplies. In the US! The world's richest country!

Got it. Thanks for expanding so I understand better what you're saying.

I'd also clarify that emergency room services being treat first, bill later is itself a form of insurance. A decent chunk of emergency room costs are never paid by patients and end up being paid by... actually I'm not certain, but either private hospital corporations or the government. However, that is only for the initial triaging treatment. If, for instance, you are stabbed in the belly and some emergency patch work is done to stop the majority of internal bleeding and some antibiotics are issued with a scheduled regimen over the next few months to prevent sepsis then there is a limited supply you've gotten by the grace of emergency treatment but if your supply runs and you're unable to afford more at the pharmacy out you'll need to return to the emergency room to secure more meds. Emergency rooms regularly serve as extremely expensive pharmacies, but they're pretty busy places and the care you're seeking could be delayed and that delay can result in a perfectly treatable infection developing to the point of a mortal wound.

While everyone in America can receive emergency treatment no questions asked it isn't necessarily going to happen very quickly and can result in more health issues than being able to pursue medical care through more standard means.