**This works this way in Panama' .  The public hospital system works from payroll taxes and the middle class top up with private insurance which allows access to private hospitals who don't treat people without private insurance or cash.   My total health insurance bill for the family is $300 per month including the money they extort for the public system but if I contract an incurable debilitating disease Ill probably lose the insurance have to pay cash for service or use the public system.**