That really doesn't answer the questions. In your dream world, there will be plenty of free rides
There are people too disabled to work (or simply too slow in the head)
Someone runs up such a high medical bill they feel like they could never pay it off, they simply drop out of the workforce and scrounge around for the rest of their life, living off unreported or untouchable income. That is already far too common among people who owe money. If I was taking home $2 for every hour I worked I would do the same thing, too
What happens when the patient is a child? As soon as they enter the work force, the first 10 years of income goes straight to the doctors? Even that would lead to plenty of free rides for cases where the illness or injury is terminal
How about someone retired who no longer has any income? Is there an insurance company that will take on a frail 90-year-old in failing health? If a hospital depletes their entire bank account and they still owe money, then what? Starve to death or freeze to death? Either way, it was still a partially free ride on the health care system
I guess we could say that all business have these things built into their costs, sort of like how stores have to charge higher prices to make up for shoplifting
But in a country that supposedly values personal freedom and personal responsibility, we do not give patients the power to do so. If I show up at the ER with a fracture and tell them I only want $1 000 worth of treatment, will the hospital see to it that I get appropriate service for what I am willing to pay? Virtually any other service provider will do so, why not medical services? Until they that, we cannot ask, nor expect patient to simply write a check to cover the costs. That is my biggest issue. We already punish the uninsured enough. If we ask them to pay out of pocket, they should only have to pay what the free-market would dictate. But there is no free market when it comes to American health care. So some of them luck into a free ride. A few are crippled financially. The rest are left with nothing at all
All I'm saying is we've had the same system for years and years and we get by somehow don't we?