The root cause of our current health care affordability crisis is a broken market structure on the supply side resulting in out-of-control costs. The (apparently) core public policy issues: insurance, pre-existing conditions, employment linkage, lack of portability, the extent of coverage, denials, out of pocket costs, and deductibles would all become non-issues if health care was a normal expense that people could afford out of their income.

The public has come to think that health care must be obtained through a third party. These third parties are incorrectly called "insurance." As the term "insurance" has morphed from a smoothing of long tail events into an intermediary in routine care, the cost crisis of medical care is now a cost crisis of "insurance." Where formerly a family might not be able to afford a large bill resulting from a medical emergency, they now can not afford a policy that threatens to eat up their entire income.

My assertions, above, require proof, which I will not provide in this article. What I will show is that a "free" and "universal" system is not a solution to a crisis rooted in excessive costs. To create the appearance of a "free" system only makes costs more indirect and opaque.

Are free or universal systems superior to a market-based system? If so, it is not because they are truly "free." The lack of a cash payment to the service provider does not mean that the service was in fact free. Nothing is "free" in the sense that valuable goods and services can not be created without costs. The lack of direct payments means only that costs are less transparent.