Ok I'm going to give you the country, it's Ireland.

Some medical card for the destitute exists but if you're working you don't qualify.

The whole medical system is a nightmare, but it's a very small country as well.

From the description I assumed it was one of the more Eastern European countries like Romania. I've never looked at Ireland like that. I assumed they had the same setup as most of western EU countries.

[Born and raised Irish, left at the first opportunity ]

Ireland is a weird (and sometimes nightmarish) mix of European and American culture. For some reason we decided that some of the dumbest ideas of the US simply had to be implemented, at great cost to the average citizen.

In Canada, specifically BC if you fail to pay monthly medical premiums you have no health insurance either they sell your account to collections and you have to pay cash for any doctor visit. Since private health is not available you're screwed and have to either leave the province to get health insurance again or continue paying cash.

There's always loopholes in socialized medicine usually only affecting the poor.

I believe Belarus is the only European one without it, Google wasn't giving me a good list of "nos", but I found a map indicating as much..

Belarus is definitely not Western Europe.