They only people that can afford to guarantee that they can pay their own health care bills, no matter what, are the extremely wealthy.
So insurance is no choice for the vast, vast majority.
I don't know any health care insurance that covers 100% of health care costs. So all consumers have skin in the game.
So there really is not an alternative available that satisfies your concerns.
Of course there are alternatives. Most of them involve doing the opposite of what ACA attempts to do. First, we need to remove all the tax and regulatory incentives currently encouraging health care consumers to over insure. That means we get rid of all tax deductions promoting health insurance, employer provided or otherwise. Then, we use the Commerce Clause as it was intended and break up state regulatory fiefdoms currently controlled by the large insurance corporations. We do the same for the AMA's control over medical schools and doctor certification. In the meantime, while we're waiting for the health care market to come back into balance, we
temporarily beef up the safety nets to take care of the people currently getting fucked over by the inflated market.
And more important than anything, we fight like hell to keep the established lobby of the health care industry from turning every single attempt at reform into corporate welfare serving their interests.