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But I was assured that Paul Ryan was a policy genius.

Insurance is risk pooling: healthy and sick share one book so one bill does not crush a family. Carve pools by health status and premiums spike for people who need care most. That is actuarial math. What would make that clearer for voters opening premium notices?

"The people who don't get in car accidents pay for those who do. Car insurance is madness"

I mean its because their world view is selfishness as policy so the idea you might pay for *other people* even if you're doing it as part of a system that will at some point benefit you, is anathema to them. they think the rich deserve health care and everyone else should die.