Of course, those Americans who can't pay, won't pay. But those who do work, who strive for the American Dream, who save and intend on sending their kids to college, will be struck by one sobering feature of the reform: without insurance they'll be stuck with paying for the entirety of their medical bills, and that debt will stay with them until they pay it off. So the reform would be a huge incentive to buy private health insurance.
Or it will also be an incentive to not seek medical care.
The whole idea behind real insurance is so that one doesn't have to pay the full price for expensive and unexpected calamities; one pays a little so that one doesn't have to pay a lot. Indeed, for healthy Americans, insurance premiums are a loss. But one accepts a small loss so that one won't be stuck with a huge loss.
And yet, if you live in an area where there is a shortage of health care services in the first place, you'll never incur that loss. There are certain people in certain situations where insurance will never help them. The whole point of universal health care, just like our corrupt public education system, is to fleece those who don't use it to subsidize those who do. Medical schools are getting rich on the concept.