$18,000 doesn't sound large, relative to the high prices we all pay. I have a good solid job, and my family plan is $24k per year. That's the most basic family plan my employer offers, but it isn't a high-deductible plan. Of course, most of that is paid by my employer, so I only pay about $4k directly out of my salary. If you are self employed, then you obviously have to pay the employer part too.