It bears repeating; all healthcare should be free at the point of service. In many, many countries this is the case. It is unfortunately not the case here in the United States. The way we pay for health insurance here is through a user fee at the point of service, not unlike how you pay for other services like a haircut or a prepared meal at a restaurant. But healthcare is also very different than those things; it is expensive to administer for a variety of factors; like the technical expertise of those administering the care or the liabilities incurred from it. It is also more difficult to calculate the cost; things can come up mid-diagnosis that require special procedures or medications, providers don't have consistent rates for cost or quality, and often times doctors aren't sure of the costs of medications or technologies they use, and many times it wouldn't matter as there isn't much of a choice in whether or not to use them.
These are only a few of the reasons we have to have health insurance to pay for the healthcare user fees in this country, but rather than providing an efficient solution to these problems it ushers in all new complications. The insurance itself is often wildly expensive, we almost always need either our employers or the government to subsidize the majority of the costs. This creates problems such as gaps in coverage should you lose your job or eligibility, many people don't have insurance at all because they don't qualify for either employer-sponsored insurance or government programs. There is also the problem of underinsurance; the insurance that you have is inadequate in what it is able to subsidize as far as the care you receive which can cause exorbitant medical debt or denial of needed care.
The result of these complications is a health financing system that oftentimes devastates people regardless of the quality of care they receive. The US is unique in that 40% of new cancer patients lose their entire life savings, over half the population reports difficulty affording care, a third are skipping out on care or rationing medicine citing cost as a primary concern, US Medical debt has topped $195 billion with a disproportionate amount being held by black americans, which alone costs financial stability, long-term health, and lives. But the lack of insurance also makes healthcare more expensive as people don't pay for the care they receive in, say, the emergency room, the providers then need to wrap that cost up in care for individuals with insurance. The whole problem compounds itself over and over again.
All of this is just a scratch at the surface of the problems with the US health financing system. The people most serious about fixing this problem understand that you have to remove the fee-for-service model that requires insurance altogether. Both Medicaid and Medicare accomplish this already in the US for people who are elderly or below a certain income threshold respectively. In these programs, the government fields the bill - or most of the bill - for the care you receive so you either receive no fee or a very little fee. This is different than the fee-for-service model; imagine you could walk into a barber or a restaurant and receive whatever you needed and it was paid for by a tab that is wholly funded by the government. This is similar to how other countries set up their health finance system. Some, like Canada or Taiwan, finance care for their entire population this way. Others, like Germany or Sweden, have a combination of a government program and a heavily regulated employer program.
There is a lot of debate about which model would work best for the US. Medicare for All is a policy that would have a single-payer, the US Government funded by taxpayers, which essentially improves Medicare and extends it to every citizen regardless of age, income, etc. Medicare for America or the ACA 2.0 would be the combination model in which Medicare is shored up to prevent uninsurance and the rest of the US is covered by a more heavily regulated version of their employer-sponsored insurance which would prevent underinsurance. Both models would represent a dramatic improvement on the current healthcare financing model.
Those in favor of Medicare for All - the single-payer program - say it most efficiently removes the problems of our health financing system by decoupling health insurance from employment, ending the risk of insurance churn (where you lose your job and subsequently your coverage), allows the single-payer system to more powerfully negotiate care costs as a monopoly, and can deliver better cost efficiencies as everyone is in one risk pool. Those who favor Medicare for America (ACA 2.0) often cede these points, but their concern is that such a plan couldn't pass given heavy polling that suggests Americans covered by their employer-provided insurance prefer to keep that plan and would oppose anything that would eliminate it. Also that the insurance companies propped up by employer-provided insurance plans would more heavily oppose a single-payer plan that would unilaterally end their existence. Which says nothing of the workers who are employed at those companies.
Of course, the reason that we aren't even on the road to attaining either model in the US is that the private health insurance industry is very powerful. There is also a non-insignificant number of people who believe that the government should have no part in the administering of healthcare financing and, although they are very wrong, they represent a substantial enough voting block in this country.
