The pieces to this puzzle as I see them:
50 million people don't have insurance, and many of them vote.
Even though insurance really doesn't = "health care," in practice that's pretty much what happens.
Polls say that only around 1.5% of those without insurance don't want it/"choose" not to have. The rest don't have employer-subsidized plans and/or say they can't afford, or have pre-existing conditions.
We don't have a free-market system. Would be nice, but we don't. We had the world's biggest welfare state as far back as 1900. We've had social welfare programs of patronage forever. We do seem to get less bang for the buck though (if you plot things like health spending w/access and against life expectancy)
We already subsidize plenty of groups of people at the expense of others.
Most people exist and will continue to live around "the middle."
In a 2-party system, parties have to cater to the middle, obviously.
The middle-class gets the subsidies.
Working Poor individuals in non-Medicaid Expansion states get neither free coverage nor subsidies.
Even in an individualistic society such as ours, people tend to overwhelmingly support things that are "for the children." So free healthcare for poor kids is mostly covered and supported by voters.
We have a tiered system, with access tied to working or not working, but also working for the "right" kind of employer in preferred industries.
Insurance coverage not only covers who pays and how things are paid, but also how much. I've seen (and paid) bills for the same exact procedure with no insurance/cash negotiated rates, employer (and taxpayer) subsidized group insurance, and private Blue Cross coverage. Interesting stuff, to say the least.
Insurance systems work best either at 100% (universal coverage) or 0% coverage.
We do have problems with health costs and access. In many ways we have a "crisis of abundance." Politicians normally want to "do something." The ones that don't attempt to do anything when there is an obvious problem are not going to win. The issue is how to approach the issue, not whether there is one. We could debate things like whether we would be better off if the government had done nothing in the wake of the Depression, for example. But most people support FDR and subsequent programs.
This is about politics, not principle. For any side- at least the ones engaged in politics. The principled philosophical arguments are good but mostly irrelevant in this context.
Politicians of all (successful) parties are good at the class-warfare game and playing up American Dream dissonance and attitudes that are not reflected in empirical data.
Like anything with taxes/penalties, there are ways to get around penalties and exploit the system.
