If you pay them, you pay for their health problems. If your government buys a bomber, all the bomber maker's retirees get a chunk of that money for health care. If you buy a car, a bit of your money goes to the health care of retirees and workers. Even if there were no "fund" to provide it - the workers would get the money and THEY would fund their health care. Unless you live on an island and have your own captive doctor, not only are you paying for everyone's health care - but everyone is paying for yours in one way, shape, or form. In essence, health care reform is mainly an income support program to make sure everyone has enough income to cover their health care needs. The reason you should be required to pay into such a program is because people get the healthcare they need whether they can afford it or not, the question is whether they get it in an orderly and inexpensive fashion or instead get it from the ER between the hours of 7 pm Sunday and 9 am Monday (the most expensive option and the status quo). You pay for that because it is provided anyway, even if the patient can't pay. The biggest impediment to efficient healthcare is actually not the payment stream, but the existence of paid sick leave for some people and not others, forcing those without it into the ER at night. The way around this is to either mandate that doctors provide medical care until 10pm every night in their offices (or at least work weekends) or give everyone paid sick leave for doctor visits. Given the political power of doctors, I expect the latter is in our future.