I never said it was only poor people. There is a spiraling issue. Uninsured people can't afford to pay when they need healthcare. This drives up the cost of healthcare, which drives up the cost of insurance, which means even less people can afford healthcare. I want you and everyone else to have health insurance that pays the bills when you need help that gets us out of the spiraling issue.
And even better than paying for expensive treatment is paying for inexpensive preventive care that eliminates the need for the expensive treatment in the first place.
I haven't seen any evidence that preventative care is an effective long term solution to rising medical costs. 25% of all hospital visits are for child birth, those wouldn't apply. Almost 50% of all hospital visits are through the emergency room, the majority of which are due to sprains, strains and auto accidents.
The few conditions that can benefit from early treatments (heart disease and cancer), I haven't seen evidence that many people would take preventative measures for those conditions but currently aren't. Nonprofits seem to have filled the awareness void there, so we see breast cancer awareness month and american heart month bring attention to those issues. There's not a lot of people out there who would take action to prevent those issues, but currently aren't. You either go to regular screenings or you don't. You either eat healthy or you don't. You either stop smoking or you don't.
Wired magazine did an interesting article last year that talked about the decision making progress of people who knew they were at risk for a disease (
http://www.wired.com/magazine/2010/01/ff_decisiontree/all/1). Often times people don't make the "best" decision, as far as minimizing future health costs associated with their behavior. It's often times only after significant negative effects have shown up (a heart attack, gum disease, etc) that people decide to change behavior. Making it slightly easier for them to be prescreened wouldn't do much to alter their decision making process. Most of the people who would have significant medical conditions that could prevented, wouldn't go anyway. It would mostly be healthy people who were already looking out for their health that would show up, adding additional costs to overall medical care. It would be the people who didn't need to show up, who would be most likely to show up. People who don't care about being healthy won't show up for optional prescreenings.
If we're serious about reducing medical costs in the country we need to address the underlying causes. We can tax unhealthy food, with the proceeds from that tax going to cover the additional health care costs associated with eating unhealthy. We aren't going to get people to stop eating Big Macs, but if those cost a bit more they might cut back. And if they don't cut back, they're at least paying into a system that will cover some of their costs when they are older and on Medicare. If the tax payers are footing the bill for some of their coverage when they're older, they should pay in more if they make poor health choices before then.
We can look at other optional poor health choices as well, if we're really serious about reducing health care costs in the country. Almost everyone who smokes for a significant amount of time ends up with expensive health costs down the road. Health insurance companies already take this into account and charge more to cover them. That same cost isn't being accounted for, for all the uninsured. Evidence suggests that additional taxes on tobacco significantly reduce the amount of total smokers (
http://www.golocalprov.com/politics/Tobacco-Tax-Is-a-Win-Win-for-Rhode-Island/). For those who choose to continue to smoke, the taxes they're paying help offset the additional health care costs they'll incur down the road.
Making people be accountable for poor health choices, and making them pay the true cost of those activities up front, not only reduces those behaviors (and reduces health care costs), it also helps to pay for those costs down the road, when taxpayers or insurance companies would have to pay for them. Requiring everyone to have insurance, or making it easier to get preventative care both work on paper but not in the real world. Factoring in the true cost of poor health activities gets us much further.