There are a lot of things I would like to address in your post:
1) You keep using this phrase "make smart choices," as if some people just chose to get cancer or chose to be born with a hereditary or genetic disease. I'm sure there are examples of unhealthy lifestyles, but there are also those who had no say in the bad hand that life gave them.
My sister was actually born with a physical disability that required many extreme surgeries when she was a child, as well as some in recent years. In fact, she was a March of Dimes poster child back in the 80's.
Trust me, alright, nobody knows better than me, nobody. It was yuge. But seriously, I do know that sometimes it's absolutely none of your own doing. But I also think people assume that it's a large percentage of catastrophic health problems, when it's probably not. I know I'm a bit cynical, but I think the overwhelming majority are self inflicted. Just look at obesity. Not everyone has a genetic issue, but that excuse gets thrown around too often as a way of excusing bad lifestyle choices.
I often think the same thing when I see homeless people. I'm sympathetic, don't get me wrong, I choose to donate. But I have an impossible time believing that a person in America can just end up homeless on the street through sheer chance. It seems to me that you have to make a lot, and I do mean A LOT, of very stupid decisions in life to end up there. But people don't like to think that, because it's mean. They're rather believe it was just bad luck and couldn't be avoided or predicted.
2) You mention democracy, but in your description of how you would like to see people handle their own decisions and choices about life and healthcare, it actually seems to be closer to survival of the fittest. Democracy does give you freedom, but it also presupposes a social order in which everyone plays a role in. It's not isolationism.
True, but where do you draw the line? As close to communism as possible? We've had these sorts of discussions before regarding private charities verses tax funded social safety nets. I believe we should be there for each other, but there are different ways of doing it. Some good, some evil. I happen to believe that it can't be forced on people, because many people are like me, and will feel resentment at having no choice and push back. It's another part of human nature, you even see it from these Antifa morons who think it's evil that they are expected to get a job and contribute to society or else they'll starve. We need to know that we do these things by choice, not because we're being threatened if we don't comply. That's my take on it. I want to help others, but I want it to be my choice.
3) I think I know what you mean with the last sentences, but I do want to push back a little bit. Why do you want us to be a "superpower"? Having power suggests that there is another side to the equation - the people you have power over (and hence your other term - empire). I would like to think that we can function as a society and as a country without having power over others AND without bankrupting ourselves. One does not depend on the other.
There is an old saying, something about the bigger you are, the harder you fall. I do not mind America's power over the world receding a bit, what I'm worried about is a full scale collapse. And I don't see anyone doing anything to try and avoid that. I mean, just look at the USSR and how it fell. This is why I'm unabashedly conservative, despite negative stereotypes, because I would rather make safe smart decisions, not just as an individual but as a country. I would like to see more people play things safe, but I don't. People put themselves in debt, make bad decisions, don't take care of themselves, etc, and then demand that the government solve their problems. But I would prefer that your bad choices not impact others, same goes for our government. I don't like this "all our eggs in one basket" feeling...
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I'm not sure how "smart choices" and "staying healthy" could be considered anything but offensive to a huge portion of folks who need reformed health insurance.
That clearly doesn't apply to your example. Those folks had the perfect storm of terrible luck, but again, to assume that the majority of cases are like the one you detailed is unrealistic. The bigger issue there is the legal details regarding when insurance companies are allowed to drop you and when they are not. I do not have a problem with reforming those legal rules at all.