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You would have to have a system where if you opt-out then you are on your own. If you can't pay, you don't get treated. If such a system existed I'm sure your dad would have signed-up (I suspect almost everyone would). Had he not, he would not have been treated and not had to worry about any bills. That sounds harsh, but that would be the only way to make the system fair and still preserve people's right to choose. We all have to live with our choices.

I'm sure my dad would sign up if at all possible. Honestly, his situation sucks because for income qualifications his wife's income counts even though it's HER money and he has no say.

The other issue (maybe I addressed it in a post other than the one you are responding to) is people who cannot afford it and would be subsidized 100% by the govt, but don't sign up. The reasons for this would vary, but paperwork could be a really big deal. As could transportation to the sign-up place, lack of internet access, not understanding what it available, etc. I would have no problems with them being treated and then HELPED to set up the insurance which could then be retroactive by 3 months.

If I come into the ER with my head spilt open, are you really going to ask for my insurance card? Or are you going to treat me? It seems obvious to me that I would be treated. If I go for an ear infection, then I suppose I could be turned away unless I had insurance or cash (under a GHI system). But after the doctors have stitched my brain together, and then find out that I do not have insurance, how do they force me to pay? I see that as a problem for not making it mandatory.

In my dad's case, he did not have insurance. He would have if he'd waited a week to have his stroke. Should they have kicked him out of the hospital? They had no way of knowing that they'd ever see one cent of the money he owed. In his case, he is paying the agreed upon amount after they forgave a significant portion. If they had insisted on the full amount he would literally be paying for it to the grave OR it would be so overwhelming that maybe he wouldn't pay it. Not because he wouldn't want to, but if you're living on nothing and have a 6 figure medical bill, that would be insurmountable. It would be easier (for some) to ignore the bill than to see it never be paid down far enough to look like the end might be in sight.

I don't have answers. Just questions.

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