[redler]

> the majority of people who don't have insurance, they don't pay it

Exactly so. They don't pay it because they can't. And they're ruined. Even people who have insurance -- good insurance -- can be ruined. This system is the ultimate form of price discrimination, perfectly tuned to extract the optimal amount of money from the consumer who has literally no pricing information, and maximize the profits of the business. When insurance companies pay out, it's referred to as "loss".

Markets and the profit motive may be "efficient", but they're not optimizing for health outcomes, and certainly not optimizing for morality. Insurance companies ultimately cannot be part of the equation.