There are things which can only be paid for before the fact by insurance because the actual costs are beyond the means of an individuals to pay so the risk has to be spread. When they are things which are often unavoidable and inevitably occur to some of us then all of us must be insured. Take the premium as a tax and let the government provide or self insure but since we all harbor a reasonable expectation of receiving medical care when we need it is is fair to mandate that all who can contribute to their insurance. Insurance is a conservative concept.