If you paid into the insurance pool, then how is the pay out unearned?

Did you choose to get cancer or fake it?

Paying into insurance does not earn a payout any more than paying into the lottery earns a payout. The payout is determined by random chance.

The point goes like this: you and a neighbor start a business. You each make independent choices on health insurance. When he breaks a leg and can’t work for a while, it’s inconvenient but not burdensome for your shared business. But, you chose not to get health insurance. Your melanoma diagnosis looks like $80,000 which you don’t have. Your business partner has a choice: should he liquidate the business, or act in the long term?

I’m not disputing your “moral stewardship” claim. I’m saying that this doesn’t change the unearned nature of the payout.

If paying into insurance “earns” the payout, then everyone who pays in and doesn’t take a payout is being stolen from.