Congress won't touch employer-provided health care, because providing health care to employees is a popular corporate tax break.
As to third party insurance: Yes, technically you can buy third-party insurance. But, no, it really isn't a remotely functional market. In short, if you don't really need the insurance, you can probably get reasonable coverage. But if you actually need it, it will be too late and nothing will be remotely affordable and/or cover much.
I was referring to things like: when your COBRA runs out. Or when you switch to a job that doesn't offer insurance, but are no longer a 20-something with no real medical history, or when you have children, etc.
Not "the day after you break your leg".
Though there's a lot to be said about not being able to get insurance to defray costs of a 'pre-existing' condition. Sure, it's unworkable to allow people to buy insurance 5 minutes after they break their leg and then cancel it 5 minutes after it's set in a cast and their prescriptions are filled. But there's no reason a contract couldn't be drafted, obligating someone to pay for a particular insurance plan for X months, complete with early termination fees and such.
Verizon and Comcast figured this out.
Is it really too much for Aetna?
That's an interesting idea, but I suspect there are legal and practical reasons why it would be impossible to implement profitably.
A major medical incident (or worse: being diagnosed with a chronic condition) can cost tens or even hundreds of thousands of dollars. Any kind of "payment plan" would likely bankrupt a good number of subscribers, and then the "insurer" (really, in this case, a creditor) is left having to make up a big loss.
My preferred solution would be for the government to strongly encourage (who knows if a mandate will end up judged Constitutional) everyone to buy into truly catastrophic care coverage, with high annual deductible limits that would be subsidized for the poor. Ideally, you'd end up with a market where everyone's covered privately from birth against actual "insurable" events.
Let employers or private sellers offer "benefit plans" that cover things like Viagra, dentistry and pregnancy with better deals than you could negotiate yourself.
But ACA combines the worst of both worlds: Mandate coverage of every politically popular treatment, often with no communication to the consumer of any price information at all.
> "I suspect there are legal and practical reasons why it would be impossible to implement profitably."
We have any number of exceptions in bankruptcy law to make such debts difficult-to-impossible to discharge. Surely such medical coverage could be worked in. And, yes, morphing coverage into essentially medical credit is the desired effect, as insurance companies negotiate far, far better pricing than individuals and credit for medical expenses is otherwise extremely difficult to arrange.
That said, I do agree to the general concept you're advocating and would prefer that sort of solution. We should just outright tax people to directly pay for the "we're not going to leave you for dead" care hospitals already provide. This makes far more sense than having hospitals eat those costs and over-charge everyone else to make up for it. Further, we should expand that base level of high deductible care to subsidize the basic preventative care that will keep the final costs of such coverage low. [1]
And then allow third parties to provide additional coverage.
Though I would most-strongly advocate a severing of the employer-health care link. If nothing else, that needs to go. The grouping of employees has serious distorting effects on the labor market. Risk pools should be insurer-wide. And insurance contributions by employers can/should be handled like a second direct-deposit. Even if we keep the employers' tax deduction. [2]
But the insurance choices needs to be in the employees hands. The risk groups need to be wider. And changes need to not be forced upon a change of employers.
[1] e.g. Basic doctor visits and generic drug coverage for things like antibiotics to cheaply treat conditions that will otherwise wind up in the ER; provide family planning care; etc.
[2] Though i'd like to see that removed and treated like any other wages from the employer-side, but exempt from income tax on the employee side.
As to third party insurance: Yes, technically you can buy third-party insurance. But, no, it really isn't a remotely functional market. In short, if you don't really need the insurance, you can probably get reasonable coverage. But if you actually need it, it will be too late and nothing will be remotely affordable and/or cover much.