Yes, either we have a risk-based insurance system or we have a single-payer system that isn't insurance at all. Being stuck in the middle is worse than both extremes in this case.
I'm not sure if it's in contention, but efficiency is also important. Life isn't an optimization for health care. At the middle class and below, people are already spending most their earnings on essentials.
Maybe you can alter healthcare so people are paying through the nose (either through highly regulated private entities coupled with incentives/mandates, or through taxes) but more people are covered, and so now they are less able to afford housing, good education, healthy foods, child care, and other stuff. Then they are not necessarily better off.
