Americans are not required to have health insurance. Generally, health insurance is tied to one’s job. Perhaps OP is a business owner and has decided to forego insurance for other things? Idk. And neither do you.

Also, it’s not like American health insurance is effective in reducing hospital bills to the point of being reasonable. It’s a trope that health insurance is a scam because it’s so bad.

Also, like all economic decisions, health insurance vs a home is a trade off, one that OP made for whatever reason. It’s not something to blame them for.

And finally, it sounds like they can afford their home just fine with outfit tradeoffs.