... is the customer model which assumes people are intelligent, rational and educated.
What if people are poor because they have a tendency to make bad decisions? What if the Bell Curve of intelligence is accurate and there are a lot of folks in the 70-80 IQ range? What if people don't go to the doctor because they're not good at cost-tradeoff analyses or because they're just lazy?
I recently had to visit a local emergency room to deal with an infected elbow bursa sac. The thing swelled up over a few hours and felt like either a broken elbow or like I'd torn some tendons. I was blessed that it was only an infection. A quick poke and drain by the doctor and a tsunami of antibiotics dealt with the problem.
While I was there, I sat in the waiting room and later in the treatment room seeing the same thing I see when I work at Catholic Charities. There were plenty of people who were in a bad way because they made lousy decisions. There was a diabetic with legs missing, a kid with food poisoning from bad tacos and who knows what else. At Catholic Charities, we routinely get overweight people missing half their teeth who opt for the pastries instead of the bread.
One of the keys to Obamacare reducing health care costs in the US is the assumption that people will avail themselves of preventative care if it's available. That's a pretty accurate model of the population with degrees from Brown and Cornell, but much less so among the poor and uneducated. Example: If the "less fortunate" were really good at that kind of planning, would they really have such high levels of illiteracy in places like Detroit? What kind of idiot wouldn't take advantage of free public education*?
If the model of the customer base is wrong, then the whole thing is just a mammoth waste of time. We'll still have people ignoring their health and getting treatment in the emergency rooms, but we'll be doing it with a stifling layer of government wrapping the economy like a shroud.
These brilliant, Ivy League ideas never work out the way they did in the faculty lounge bull sessions.
* - Answer: A common, every day, ordinary idiot.