So… the current answer is history, tax policy and the consequences of doing things a certain way for a long time.
The “why did this start” answer “insurance” works better like this. If a large company, union or somesuch goes to an insurance company for a quote… the insurance company can assume that average health costs will be average and price accordingly.
When an *individual* went to an insurance company for a quote, that individual might be seeking insurance specifically because they have high health costs. They can’t just assume average health costs. This was especially true before health insurance was the norm. At that point they try to figure out how healthy the patient is and “insurance” stops being insurance and starts just being “service cost.”
Health isn’t random enough for insurance to work smoothly, without some sort of aggregation method. That’s why this got started. From there… decades of history, policy, norms and whatnot
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