A simple process bug
"People who were already able to afford health care began to stop paying for it so they could get it for free"
This is simply growing pains from trying to re-invent the UHC wheel. If Hillary not been pressured to curtail her universal healthcare efforts by those with a high fear factor, we would be on track by now and able to keep up with the rest of the G7 group who's currently using UHC.