I've misinterpreted some of your previous comments. There ARE conservative bloggers and blog commenters who are arguing precisely for strict individual underwriting where the sick pay the full risk adjusted cost themselves. If you are 30 and healthy, you pay $50/mo. If you are 55 with heart disease, you pay your full individual burden. More charitable ones suggest govt subsidies if that comes to more than X% of your income (where X is usually >10 and <50). Less charitable ones say "life is unfair".

I've been thinking your position was in the "charitable libertarian" camp. Some sort of non-employement based approach where individuals buy into large groups makes sense.

The problem comes in how you let the groups run with light regulation, but don't let them simply cherry pick young/healthy people only and so some loser pool winds up with all the old/sick.

You actually see this play out in federal employee plans. The way the feds provide employee health care (members of Congress included -- they're on the same plan, under the table perks notwithstanding) is that employees choose from a menu of about 25 different plans, some state-based, some national. The govt pays 75% up to a hard dollar limit. Plans have to take any employee who signs up. It's actually very well administered, slick web-based management with lots of data available to compare plans.

Over time, there have been cases where a new plan starts up with a great premium/benefits balance, but then all the most sick employees flock to it and the plan is driven out of business. The govt has dealt with that through minimum benefits rules and such, but there is evidence from the program that in pretty free competition you tend towards cheap, high deductable, lower benefit plans that attract the young/healthy, and generous, low-deductable plans that attract all the older/sicker enter a death spiral of gigantic premium increases. Again, managable but with some regulation of the competition.