Only three states don't have mandatory auto insurance,
New Hampshire, Virginia, and Mississippi. All have other financial requirements instead:
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In New Hampshire vehicle owners must satisfy a personal responsibility requirement instead of paying monthly premiums, and prove that they are capable of paying in case of an accident. In Virginia vehicle owners may pay an uninsured motorist fee. In Mississippi vehicle owners may post bonds or cash.
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The question remains, how to willfully choose not to treat those self-insured who don't have wads of cash in their pockets at the moment the piano falls on their head? There was a thread here awhile back about a fire department that watched a house burn down because the homeowners had refused to sign up and pay for the service (it was a remote area with no city taxes to pay for it.)
The outrage in response to that story was palpable--not to mention the homeowner himself was running back and forth screaming that he'd pay it now, he'd pay it--and they didn't even let someone die. We are a society that
will treat people if they need medical care. That's a reality. So the rest of our decisions have to be based on that fact, and not pretend that it would ever go any other way when someone in severe need of medical care walks into a hospital.