I think we are ignoring a very important fact here: Nobody thinks it is the federal government's responsibility to provide either health care or insurance.

What we are conflicted about is a set of laws and regulations that define how insurance has to work. Democrats say insurance has to be real insurance (everyone in the same pool, no exclusions, no caps) and Republicans say it should be any piece of crap the insurance companies want to sell (very selective pools, exclusions, and caps).

Well, we already had the Republican version of "insurance" for centuries and it gave us medical bankruptcies, closed hospitals, lack of rural care, very dangerous (to everybody) public health problems like homeless people walking around spreading TB, and so forth. Why would we want to go back to that non-functional model of laws and regulations?

It absolutely IS the federal government's duty to provide governance that counters the worst that businesses can do. By their very nature, businesses only purpose is to make money. Government has to supply their conscience because they have no incentive to do it themselves.