I find it funny how you imply that there's no easy answer here.
There is no easy answer. I won't break down the rest of your post piece by piece because it is long and all interrelated. But I feel the answer is more complicated for two reasons which you seem to ignore:
1) The aforementioned moral dilemma present in the majority of Americans.
Individual Liberty versus Paternalism. In reality most Americans are torn between both principles. They simply can't choose between their self interest and that of others. All people in this country have at least some sense of individual liberty, the freedom to do what they want to and how they want to. In a way that is part of being American. But in the same manner most also have some sense of altruism, some drive to see that collective help is there for others when they need it. Human beings are by nature social animals, not entirely self-interested.
Even political libertarians, who proudly tout individual liberty, would mostly never set policies that allow for poor children with a preventable disease to go untreated. And most liberals in the country still hold true the ability to make decisions for themselves in some form. The dilemma is present in almost all Americans to some extent; our country itself is contradictory because in it's very founding and subsequent nature it is
both paternalistic and libertarian.
I can guess you are a strong libertarian. You feel that each of us is their own person and what everyone does is their own business. You're proposal is to simply make everyone pay for it. If they can't: "Let them eat cake." At the far end of Paternalism, one's proposal would have the fed govt. make the decisions for you in a single payer system, because that would be in the best interest of everybody and insure everyone has equal access. In my opinion, neither would work because of this moral dilemma. It complicates the issue, making seemingly simple solutions, on either side of the spectrum, ineffective. As such, I think you have to compromise between both principles to implement a system that is
truely American.
2) The economic consequences when people do not have access to medical care.
There are drastic financial consequences (on both the individual and societal level) when a large portion of the population is uninsured. This is largely due to the common sense that an unhealthy workforce = an unhealthy economy. A huge portion of our uninsured are those in the lower middle, our economy's bread and butter. When that demographic is incapacitated or suffering from a chronic disease and our system is incapable of fixing it, our economy's productivity and efficiency decline. Bad for me, bad for you. Less room to excercise our "individual liberties."
Also, when an uninsured person checks into an ER in a tax supported hospital, the government has to funnel in more taxes. Even worse, the hospital partially covers the cost of uninsured patients by "shifting" it to the general consumer markets. This cost shift is by far much worse than the previous problem. Because we have uninsured in this country, you spend more on everything from a cup of Starbucks to a Ford Taurus, among other serious consequences. And these companies are put at a serious disadvantage to foreign competitiors. If you don't understand how the cost shift works, I can link you to a previous post of mine that explains it.
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So that's my piece. I think we need a UH system for economic reasons, and I think this system needs to compromise along the lines of this moral dilemna. As such, you need to ensure all people are accountable for their actions and pay for their own medical care in at least some form (like what you describe), but you need to ensure that all people have access and can get treatment when they need to (like what they describe). Tough, but I think it's possible, although it would not come from one of these simple solutions. How would I do that you ask me? I'll tell you tomorrow, I'm exhausted from hittin' the slopes all day.
