If they can afford to pay, they shouldn't have to work at all. However, everyone can have the options of selling themselves into slavery and the master will gladly pay the bills.

Are there no work houses? Are there no cemeteries?

In reality, ruthless ideologues like Ryan want people who can't pay for their own care to die. A national health "cleansing" to strengthen the national stock.

The Kochs call themselves libertarians, but I suspect they're just really fascist-leaning like their dad.
Their goals would lead to a national die-off also, but they seem mostly motivated by not having to pay into tax funds for anything for anyone else, who are free to live or die as they can manage on their own.

In both cases, people would work until they couldn't, live until they ran out of money, then die.

According to Trump advisor Kellyanne Conway, people on Medicaid should go out
and get a job to have health insurance.

Babies could be used as door stops too. All must work!