Most people aren't going to have more than one or two claims on their catastrophic major medical, if any, prior to turning 65 and going on Medicare.  So, it's cheap, and can be paid for out of your HSA.  And most people aren't going to spend their entire annual contribution in the HSA every year.  Many of us won't spend any of it.  And what we don't spend accumulates like an IRA.  If you suddenly drop dead of a heart attack, the money goes to your heirs, not the government, and not an insurance company.

We had set up one of these for our daughter so that she would never have to be tied to an employer for her insurance coverage.  But the ACA made it illegal.  That was a concern to me because when my first wife got pregnant with our 2nd child, I'd just changed jobs and the new coverage wasn't in effect yet, so she wasn't covered when she spent a month in intensive care back in the early 70's.  It took 2 years to pay those bills off.