If basic health care should be a privilege of wealth reserved for those who can afford it, then it should be financed through profit-seeking insurance companies. But if it is the right of all Americans to have access to basic health care regardless of wealth or poverty, then it should be financed from tax revenues and should never be managed by those who profit from attracting only healthy clients while repelling the sick through deliberately poor service.
I think most Americans believe that basic health care is a right, not a privilege of wealth, and that, like police and fire protection, it should be available to all regardless of ability to pay. Thankfully, we have “socialized” police and fire protection and “socialized” road construction. Sure, competitive private enterprise could provide an array of different levels of police and fire protection (from very good to virtually zero) at different prices, and all roads could be privately owned with tolls set to maximize total revenue, and then the poor would often just have to do without those “privileges of wealth.” But that’s not the kind of society we want to live in.
Some opponents of “socialized medicine” would have you believe that profit-seeking companies can be required by law to serve all comers equally regardless of their ability to pay, and whether they are healthy or sick, and that the profit motive will make everything better. Not true. If the insurance companies are “required” to provide the same quality of service to those who need frequent medical care and can’t afford to pay much for it, as they do for those who need very little care and can pay high insurance premiums, the profit motive will be a continuing fly in the ointment, not a virtue. Every attempt to even approximately equalize the service level will be doomed to failure. Market forces will drive the business to maximize profits and serve those who can afford to pay the most. That’s what the market always does, and that’s fine when you’re allocating the privileges of wealth.
If we really believe that universal basic health care is a right of all citizens, like police and fire protection, then let’s finance and manage it in the same way. It actually works pretty well.