Bill, maybe you can assist me: here's the problematic quotation:

“If you have a law that makes explicit that healthy people pay in and sick people get money, it wouldn’t have passed,” he said in one video. “Lack of transparency is a huge political advantage, and basically call it the stupidity of the American voter or whatever, but basically that was really critical to getting the thing to pass.”

Healthy people pay in and sick people get money... isn't that just a description of the way insurance works? People whose house did not burn down put in money and the person whose house did burn down, gets the money.

Seems to me the insult is not believing that the US public would "get" that. IME people do perceive health insurance as a special case, often expecting to get back more than their premiums or it's a bust- until you point out to them that if everybody did that, there would be no $ left for expensive unplanned care or when the house burns down, which surely is the purpose of insurance. I've never met somebody in the US who didn't "get it" after that discussion.