People who lived paycheck to paycheck had NO health insurance. This was the problem obamacare was trying to fix. Something like 20% of the population of the United States has no insurance or terrible insurance. You can try to pretend that this isn't true, you can assert loudly that it is "their choice" not to buy insurance, but -- remember, they are living PAYCHECK TO PAYCHECK or on NO PAYCHECK AT ALL. If they chop out $200 to $300 each month (or far, far more) for insurance, you're just saying that they have a choice between eating, or wearing shoes, or living somewhere other than under a highway overpass, and health insurance.
My wife is a physician and has been taking care of these patients for her whole career. Your "free market" solution for most of her career was this: If an indigent patient (or one who lived paycheck to paycheck, or one who just couldn't/wouldn't afford to pay) walked in to see her, she could see the patient, accept whatever medicare (elderly) or medicaid) (poor) payments they might qualify for -- well under the market value of her billable time -- or just see them pro bono, which she might well do for a patient she'd been seeing who lost their job. Hospitals were in an even worse state. If somebody walked in off the street into a hospital ER, they were LEGALLY OBLIGATED to take care of them, whether or not they could pay. Even a very small hospital/ER visit costs a lot of money, and medicare/medicaid (if it pays or paid anything at all) payed only a small fraction of the actual cost of the visit.
Your "free market" pre-obamacare solution was thus to screw the physicians and hospitals and nurses by simultaneously requiring them to provide medical treatment to people who couldn't afford it and exploiting their good nature on top of that for people living on the edge of the poverty who -- at best -- could only afford to pay something much less than the cost of the service and cannot possibly afford even the cheapest health insurance. And before you even start, let me assure you that for a physician in pretty much any practice, overhead is AT LEAST 2/3 of their billing, maybe a little bit more, so a free patient isn't just a matter of a physician contributing a bit of time, it is contributing their own time and PAYING their nurses, receptionists, PAs, for the lab (and any labs they order) and of course there is the building itself and all utilities all paid OUT OF POCKET -- directly eating into their income. This isn't a zero sum break even games, they lose money for underbilling and collectable accounts, and medicare/medicaid doesn't even pay for the overhead on the visits they supposedly pay for. So yeah, in order not to go broke WHILE working 60-65 hour weeks for half of what they would be making in a "free" market, they charge 30% more to everybody else (more like 100% in hospitals, where hospital ERs are the most expensive possible way to deliver routine health care). Guess what! You've socialized medicine, but in the worst possible way, the least fair way. And the saddest thing of all is that people don't even realize that this has happened, and yammer on about free markets and how having competitive insurance plans is somehow optimal and can take care of everybody that needs -- is mandated in law -- to be taken care of.
Obamacare didn't fix this problem, of course. It did, however, make it a lot better, and more fair, in that by increasing the number of the insured and directly subsidizing insurance for the working poor who previously had to rely on the charity of doctors or hospitals to get medical treatment or routine well-patient care, they passed the costs on to the people of the US collectively instead of forcing the physicians and hospitals individually to do what they insisted that they do, at a loss. And I'm not just talking the unemployed, I'm largely talking about precisely those living paycheck to paycheck, often working several jobs because employers don't want to have to provide benefits and only let them work 30 hours a week (each). I have three sons doing just this, and without obamacare and the 26 year old rule only one of them qualifies for an employer group health plan, and THAT is so expensive that he opted for high deductible insurance (so they could afford food, clothing, day care) and got totally screwed when he had a major health issue that lasted two years before they finally figured it all out. One is on obamacare, and as the person who actually pays for the insurance I can assure you that it is way cheaper than it would be otherwise. One is still on my group health insurance (for five more years, if congress doesn't trash a perfectly good thing that yes, I'm paying for but at group rates).
My wife is firmly convinced that unless and until we go to a single payer system, health care in the US will remain the way it is now: massively broken. We are all firmly convinced that if the US congress were required by law to use the health coverage they think is "adequate" for medicaid or medicare patients or if they were required by law to get their health care through the national VA hospital system (my wife currently works for the VA and has to wrestle with that special brand of crazy that dominates it) all of this would literally be fixed overnight. The US is behind almost all of the developed world in the tortured and demented way we provide insurance and drugs and health care. The system is anything but a free market, and as long as human poverty and disability and greed remain the way that they are will never BE a free market unless you are prepared to see people literally dying on the streets for a lack of health care.
Most people think that would be a bit barbaric. I certainly do. Beyond that, the only question has always been: Do we come up with a plan that is universal and fair, or do we try to force physicians to cover the vast distance between universal and fair by hiding the costs of universal under a thin veneer of "capitalist" respectability that makes it both socialist anyway and incredibly unfair. While (double bonus) maximizing the profitability of the insurance and big pharm industries and maintaining those all-important political contributions to BOTH parties from the insurance and big pharm megacorps.
Human rights are, of course, an illusion; life in a state of nature is ugly, nasty, brutish and short (to semiquote Hobbes). We INVENT things like the right to life, liberty and pursuit of happiness and it is up to us to invent and establish a society where those "rights" have some meaning. It is up to us and only us to determine whether the right to "liberty" means "the freedom to starve" in a world where we have sufficient wealth to provide a decent living for every single human and still have plenty of room left over for a strong system of differential rewards for labor and sacrifice. This "utility pool" is only going to become broader and deeper over time as we invent ever more labor saving devices -- robots, automated manufacturing, sales, and delivery systems, tractors that run themselves, cars and trucks that drive themselves. We can do a lot better than the freedom to starve, the freedom to suffer and sicken and die, a life where happiness is literally impossible to pursue due to the accidents of our birth, the accidents of our life, or the vagaries of the economy.
Was obamacare a perfect solution? Of course not. With the entire country polarized, ripped apart between competing and utterly illusory memes of the ideal free market capitalist society and the ideal managed market communist/socialist society, mere common sense didn't stand a chance, and still doesn't. Congress votes on the basis of a complex religion that doesn't even have a fixed scripture or universal set of rules, and congress is for sale because we have systematically created a democracy where one cannot even dream of running for office without a stupendous budget for advertising, a budget that can only be realized with corporate money, money that only appears in your coffers if you promote policies that don't bite the hands that fill the coffers and from time to time throw them a juicy pork bone. With Big Pharm and all the insurance companies and HMOs in the country advocating on both sides of the aisle for solutions that let them continue to make enormous profits, how could anything work? And hospitals and doctors themselves aren't always saints either, but forcing them to do what we wouldn't force a mechanic to do -- to fix EVERYBODY's car, and if you can't afford to pay for it, well, the mechanic is responsible for buying the replacement parts and fixing it and paying all the overhead for his tools and garage and don't forget taxes on all of the above -- is not a reasonable or fair solution.
And before you go there, things that would work for cars (which we can at least imagine are NOT actual necessities of life itself, so sure, forcing people to earn the money to support them or do without is at the very least less crazy) would not work for people, at least not unless you are comfortable passing the corpses of men, women and children abandoned on the side of the road the way we now sometimes see dead cars.