Beyond that, given the perverse 'market' for health care in the US, even if you can (theoretically) afford to self-insure, the pricing mechanisms and negotiating power of insurance companies practically ensures that they can offer you premiums for less than your out-of-pocket cost for even fairly pedestrian services.

There are (or at least were when I sold insurance) products that costed very little (compared to an actual plan) that provided you with the negotiated price the insurance company would pay if something happens. If you can afford to self-insure, the best bet would be to buy one of these products and store the rest in the bank.

No clue if those things exist anymore with everything going on in the world of health insurance, though.

But you really can't afford to self-insure, even if you're young and healthy. There's always the small but real chance of getting a catastrophic illness and running up a million dollar bill.

Therefore, you really need to buy at least catastrophic coverage. And that's real insurance, not self-insurance.

Health insurance is complicated because for most people, it's so much more than just insurance. It's prepaying $300 a month so you don't have to pay $200 to visit the doctor once per year. No, I don't know why people do that. You're right that paying $100 a month for "please reattach my severed limbs" insurance is more affordable. Terminology be damned, that's possibly what people mean by "self-insured". They pay day to day expenses out of pocket.

Fortunately, the catastrophic insurance can be pretty cheap, if you choose a high excess.

You don't completely self-insure, instead you get a high deductible play ($5,000 - $15,000) - also called major medical or catastrophic insurance.

That way you insure the vast majority of things, but you are covered for the really insane stuff, plus you get the benefit of the negotiated rates.

> If you can afford to replace everything you own out of savings, good for you, but most people can't.

Exactly this. The advice I was always given is that if you can afford to replace x (whatever x is) if something bad were to happen, then it's better not to bother. But if you can't, and x is necessary for your life, then you need to accept insurance as a necessary evil.

> If you can afford to replace everything you own out of savings, good for you, but most people can't.

Not that it's relevant, but I can't. Anyway, I didn't say anyone should plan to replace everything from savings. My point is, whatever you _can_ replace from savings, don't waste money to insure _that_.