The universal participation structure is justifiable when evaluated as a long term investment in healthcare rather than as an annual investment.
Over time, those in the bottom 50% (expenditure) will move into the top 50%...
some will Transition gradually ... some abruptly
And with no designated minimum/maximum time period spent in the bottom 50%
Many people, once in the top 50%, will migrate annually from one top 50 percentage category to another-- some years requiring greater expenditures than others....
If insurance 'benefits' are viewed as a return on a long term investment....then it becomes a given that the investment will produce a return...
Theoretically, the long term ROI will be greater in a universal system because the premiums are designed to distribute the weight of the risk ...
Which is different than the common misconception that it shifts the weight of the risk created by the top 50% onto the bottom 50%...
since in the long term virtually all participants will have been part of both the top & bottom...
Having said that....
the only way any insurance structure is worthwhile is if all participants can actually afford the monthly premiums...
So while I understand and embrace the long term investment philosophy of universal participation..
I, currently, have to make a choice whether to invest my available funds in healthcare insurance or in a housing & education combo ...
Since I only have sufficient $$ available for investment in one or the other... not both...
As it stands, the housing & education combo is a higher priority ....