It's actually explicitly not mandatory.
If your only options for insurance are unlikely to cover the expected costs of your care because of their terms, then it's only a loss. If your coverage might cover tens of thousands of dollars of surgery that you couldn't cover otherwise, then it's prudent to take the insurance fee loss than the surgery loss.
In a system where insurance doesn't exist but the government also doesn't fund it, each individual person would be financially crippled with debt if anything ever went wrong. We've also seen healthcare savings plans and mutual funds equally or even moreso capable of such fraud and unethical terms.
Ideally, we would elect representatives who want all healthcare funded through the government. The government is very clearly capable of operating at a deficit, and in fact would spend less under that system than they do currently on healthcare through subsidies and programs which compete with insurance companies despite not having authority over medical pricing.
I actually think a better analogy is treating it as a tax than a racket, currently. It's still not accurate, but if you avoid paying it long enough then you get the mother of all fines. If you avoid paying a racket, you'll also get the mother of all fines, because they're gonna break your fucking legs.