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In the American health care system, those who don't have the money to pay for health care--even people with serious illnesses or injuries--often simply get no medical care at all

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In the American health care system, those who don't have the money to pay for health care--even people with serious illnesses or injuries--often simply get no medical care at all.  Is this a fair system?  Should health care be available only to those who can pay for it?  Only the well-off?  Why or why not?