Just a thought, "paying nil significant taxes" would mean lower or nil income...? we could also include refugees, prisoners in that group I guess.... these people, may also be providing a huge extra to society in the form of being low paid, having future potential or not adding to externalisation costs such as increased infrastructure needs higher income earners do... also I think the main criticisms of the US health system is that insurance is in most cases part of the job contract and that there are huge (cost) inefficiencies due to insurers battling over coverage costs with health providers... as an aside I live in Romania and as a low income earner I forgoe insurance because it's a lot cheaper to get care when I need it