Two problems with the old model.

First, a significantly greater share of spending now goes into the managing of chronic conditions -- no longer is it that you'll pay a bit to a doc for your strep throat, or, you'll be in the hospital having your appendix removed. A lot of money goes into long term drug and other therapy and that poses a real problem for an "insurance" model that covers unusual, unexpected expsnes.

Take my case. On January 1 every year I know for a fact that I'll rack up just short of $10,000 that year in diabetes management assuming total steady state and nothing going wrong. That's a lot to shell out -- especially once you add in your hospitalization type coverage (given my condition, especially) plus an allowance for other routine out of pocket treatments (e.g., my annual sinus infection). I'll be the first to admit that there is a net transfer from society to me every year -- $10,000 on care vs $5,000 on premiums plus deductables and co-pays. In Tom's world I could easily be paying $25,000/year on health care just for myself, which I could swing if I had to (like my wife and I living in a 1BR apartment instead of a house), but for many would be damn tough to pull off.

The more serious problem is that the evidence is that when people are making choices and face full out-of-pocket costs, they systematically underspend on medical care. They do not do regular preventive care. Even people with known conditions are strongly apt to skimp on their recommended care in order to keep up on other sorts of consumption. Since that kind of skimping leads to people ended up in serious condition, it either means that your hospitalization coverage will be much more expensive than it needs to be, or that you have to be willing to make people suffer the consequences of those choices.

So which will piss you off more? Having taxes go to provide routine, comprehensive coverage for other people today? Or having your hospitalization ins rates much higher than they'd otherwise have to be to cover the people who end up in critical condition because they didn't manage diabtes, hypertension, infectious diseases, or whatever?

I'm not saying I like that, in fact it pisses me off too. But that is the way your fellow humans behave, unfortunately, and there is no easy solution. The studies are pretty clear that when faced with paying their own routine costs people skimp on care that leads to longer-term higher costs.