Full article appears in the Winter 2018 issue of Jacobin. When the GOP passed its austerity tax plan late last year, it also ended the means of enforcing the Affordable Care Act's individual mandate penalty, a move meant to destabilize the ACA, allowing an imagined healthy population to cast off the shackles of mandated insurance and thereby remove their contributions from a pool meant to spread risk evenly. Republicans rejoiced at gutting the mandate, as well as, they'd hoped, President Obama's signature legislation. Democrats feared for such an exodus of the healthy from the private market. Both viewpoints share the notion that individuals purchase health insurance like one does soda pop.In Jacobin, Natalie Shure writes that "this urge to fix the health care system by tweaking individual incentives and optimizing consumer choices" is emblematic of for-profit health care's consumerist "hellscape" where cost burdens are ever-offloaded onto individuals, to protect corporate bottom lines."As insurers struggle to maximize profits amid ACA rules preventing their most barbaric tricks...they've ramped-up cost-sharing. Some 40 percent of Americans now hold a high-deductible plan...around 37 percent of them have foregone care due to high out-of-pocket costs, with little distinction between necessary and frivolous treatments. Smaller user fees like co-pays have an impact on lower-income patients, whose health outcomes deteriorate when charged even modest amounts at the point of use.Cost-sharing has become so burdensome that the Commonwealth Fund estimates around one-quarter of American adults are underinsured — that is, they have insurance but can barely afford to use it."You can read the full article in the Winter 2018 issue of Jacobin. For a limited time, $12.95 gets you not only this health care-themed issue but also the latest issue of Dissent, which boasts a special section on Medicare for All.