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This is not coming from a mean spirited place, but "what if all American's cancel their insurance?" Well, it will never happen unless there's a practical, immediate, and acceptable alternative available. So, we can feel free to play through the scenario in our heads, but if I'm going to go day dreaming, I'm going to dream about stuff that's way more fun to think about than health insurance (like what if I had superhero powers or what if I won the lottery jackpot).
The hard reality is that healthcare without some kind of medical coverage (insurance, medicare, medicaid, etc) in the USA is not practical. Younger and healthier folks, people without kids or other dependents, and things like that can make do without, and many do.
However, there's already a huge pool of people who get free or significantly reduced cost coverage via programs like the VA (for veterans), Medicare (for seniors), and Medicaid (for poor and disabled). Another giant pool of people receive heavily subsidized health insurance via their employers, because the employers pay some or all of the premiums. Although that group often complains about the cost and quality, many/most of them still know that it's very risky to go without and that there's at least some level of return on investment there that makes it still worth it. Then sandwiched in with that group are the young adults who are on their parents' insurance so they don't really pay for it themselves anyway.
While those groups are full of people who are like minded and want to see reform, you'll never see significant push back and willingness to stop paying from those groups. So, it's really only a relatively small block of Americans who are bearing the entire brunt of their health insurance costs and who could potentially get by without it, who would also be willing to. And that pool isn't likely large enough to affect significant change on its own. You'll basically get half the country telling them to get a job (completely ignorant of the reality of the situation), another third of the country telling them that it's a choice they made and others shouldn't have to pay for it, and the bulk of the remainder that aligns ideologically but who aren't in a position to drop their healthcare coverage.
Keeping in mind that I've obviously glossed over a lot of details and caveats because at the end of the day this is just a long assed comment and not a dissertation.
But, isn’t there an alternative? You just go, accept the debt, and eventually file bankruptcy.
Sounds fucked up, but at the same time… what’s the number one reason for bankruptcy in the US? We’d just be doing so on our terms by that point.
No, there is no practical, immediate, and acceptable alternative available.
That's not really a viable option for most people in the USA.
Bankruptcy in the USA is expensive in and of itself, comes with a lot of limitations, and still requires you to sell your property (if you're wealthy) or continue to pay off the debt (if you're working class). No way I can cover all the cons and reasons that's not an option for most people, but basically it's a huge gamble and is liable to leave you in a worse off financial situation than if you'd just maintained insurance.
Also, most people's medical care comes from primary care, urgent care, pharmacies (i.e. non-emergency care). These are places where you pay up front or you don't get service / prescriptions / care -- particularly if you are uninsured. These places do not have to provide service if you can't pay.
For emergency room care, there is a minimum standard of care that they must provide regardless of ability to pay, but it's (hand waving here) basically just patch you up enough to temporarily stabilize you so you can be pushed out the door. Overwhelmingly, people who've been to the emergency room require follow-up care (not provided by the emergency room), and that follow-up care is similarly pay up front or no service. The emergency room also isn't going to manage all the routine stuff unless/until it's at a life altering point, and if you wait that long to get treatment for those types of things, you pretty much always end up much worse off in the long run.
So again, this is not really an option for most people or most ailments.
I think that’s largely true, but aren’t you skipping the idea of a chapter 13 (is it?). I thought there was a major difference between chapter 7 and 13, being that you aren’t required to pay anything back. You may still have to forfeit some assets, but you can also keep assets like a car so long as you can prove you’re making payments and you need it. Also consider, the people who can’t afford insurance and would thus take this option probably don’t have much in the first place. I’m not a lawyer though, what are your thoughts?
Keep in mind the context of this conversation is "What if all American’s cancel their insurance."
Although the premise of this conversation is regarding all Americans, cancelling insurance is only relevant to the subgroup of people who are currently paying for insurance. That excludes a huge chunk of the population right off the bat, including the people you mentioned who can't afford insurance (but also don't qualify for other options like Medicaid). There's nothing for them to cancel because they are already uninsured, they don't play much of a role in affecting change in this scenario.
On the topic of bankruptcy, the differences between the options isn't super important in this context. The majority of people filing for bankruptcy don't get their debt wiped for free, it's still a costly and risky option to rely on, and it's far from being a practical, immediate, and acceptable alternative to maintaining health insurance. Would relying on bankruptcy work for a single person, relatively healthy, with no kids or dependents, few or no assets and low income? Sure. Does that work for the majority of people, who have dependents and/or health issues, own things, and make a typical income, no not really.