In reality most can "afford" it (albeit there will be lifestyle changes for at least a short period of time to pay the fees). The people that truly can't are those without insurance.
Even the "worst" insurance usually tops out with a maximum yearly out of pocket around $12,000. Everything g after that is paid by the plan. Also, count on about half of the billed price being waived because American insurance companies negotiate the lower wage.
Now, there are a few reasons this kind of works (just not well). One is that we aren't losing more than about 25% of our wages to tax. The rich technically should pay more, but they exploit loop holes or sweetheart tax laws like capital gains tax rates that are much lower. Also, consider that approximately 47% of American get more than 100% of their federal income tax returned to them at the start of a year. If you have children you can expect approximately 3,000 per child depending on if your state also has a child tax credit. These are just some ways we bridge the gap; solving long term problems with short term solutions like "hey, let's just pay this with our annual return."
Personally, my state is becoming one of the most conservative in the country. I have a lot of friends who are tea party Christian fundamentalists. They complain incessantly about taxes, how unfair they are, and why the rich shouldn't pay as much. They also tend to favor a flat tax which has been proven to be harmful to the lower and middle classes (and it gets rid of the tax credits and write offs, hence flat non-graduated taxation).
Being that it is tax time I get to see interesting results this time of year. My bible thumping tea party friends with 4-6 children are getting more than 10,000 back on a single income in the range of 35,000-45000. They keep their wives out of the workforce so they can home school their children to be religious. The government, and myself, effectively pays them for being fiscally irresponsible which is ironic. I have a child--I just don't collect them like Pokémon because I can't afford it.
It isn't just our health system that is broken. I say fuck the pharmaceutical companies, but they aren't going g away any time soon. Their money and bribery will continue to grow. And India is known for its bribery.