Bought insurance for the first time earlier this year. Bought an Allianz year long policy for both wife and I for $485. As a percentage of total spend for travel in the year it was pretty low, so I was good with it. Turned out I got Covid in Europe so it paid off. That said, agree that most US based travelers could be tempted not to bother, while anyone coming to the US better have some kind of insurance to cover a medical issue.