"It's one of the few businesses—schools are another one—where your profits depend on the class of customers you get as opposed to the service you provide. That is a perversity that the market has not overcome."

On the surface this looks correct. It also points to why the basic no frills version should be state provided.

However no company has ever gone broke because its market share increased as long as they had no loss leads.

If an insurance company properly calibrates its risk:reward it can both make a profit and serve more customers.

Problem is that you cannot just outsource all if the building blocks of a health system overseas. You also cannot take a selective approach to modern medicine as a product in isolation. All the factors of ones lifestyle add into ones health profile. What you eat, how much you exercise, type of work, hours of sleep.

Most health systems are setup to deal with the end results of a lifetime of good and bad choices. Preventative health care and individual responsibility are tacked on too late into the equation.

Need to take a more holistic approach on individual lives. So how does a health care provider do that?

Buy there own fitness centers and give discounts too health care based on results?

The thing is your lifestyle is your choice. To make it health insurance viable for a lot of profit motivated companies will require your lifestyle to be their choice.