Could people even buy health insurance in 1789?
I’m thinking not but I actually don’t know if there was anything to the contrary in the USA at the time.
I think our reasonable private system was “fundamentally changed”. My premiums used to be about $45 a week back in 2001. Been so long since I had insurance, I only remember the old days.
In general, though, insurance was a huge industry. I believe it was the second-largest industry in the U.S. -- after shipbuilding -- when this country was established.