It's also designed to keep people dependent on their employers. You land a salaries position at a company that provides one of the few decent healthcare plans in the US, and suddenly you'll put up with a lot of shit to keep that job...

There hasn't been a tax penalty in the US for not having insurance for years now.

Until you need surgery and it's 400k. For clarity insurance is a scam. Not going without it in today's climate is taking a massive risk, though

Total scam. Shouldn't exist. I hate it.

It’s cheaper to pay cash than use insurance.

Yes, for most people, in most years. But the cost of health care tends to be very, very unevenly distributed. A person might see medical bills of less than $1000 per year for 20 years and then get a single $1,000,000 year. So at that point, it's an annualized cost of $50,000 per year, even if most years it's about $1,000. Some estimates are that 10-30% of all medical spending in the US is in the last year of life.

Many believe that because of this distribution, health insurance should primarily be a catastrophic care model where most people pay a premium that doesn't cover anything for the first few thousand, then covers a percentage of the cost up to the out of pocket maximum of like $15,000 or so for a family, but does cover everything after that. For a typical household, being able to predict annual healthcare expenses for the entire year is very useful.

And personally, I'm pretty sympathetic to this catastrophic care model as a short term transition to an all payer model that looks like Switzerland's system (private insurance, private providers, mandatory coverage, strict price controls, and subsidies for anyone who can't afford the normal premiums).

If you could predict everything perfectly then that’s fine. What if instead of a normal delivery, you needed a week in the NICU? Then that $20k quickly becomes $100k.