so I recall back in the day when I was in highschool watching a guy on tv blow his brains out on an overpass with a shotgun because apparently his hmo(managed care insurance with a bunch of bullshit rules) screwed him and he couldn't find any recourse other than that.

Just having decent health care is a struggle in america. if you don't have a job and you are not independently wealthy you are basically screwed pre-ACA.

Not having a single payer healthcare in america also changes the risk calculus of starting up your own business.