Petition To Opt Out OF Government Healthcare

I am fed up with Government intrusion into my life. I am afraid that Socialist programs meant to insure adequate health coverage for all Americans will further undermine my ability to choose. I believe that medical decisions and the method to pay for them are best left to the individual and their medical provider. This freedom of choice is a cornerstone of the foundation of our great country.
Therefore, I ask that I, and others like me,  be allowed to opt out of any and all government sponsored program(s) in relation to healthcare. I agree to;
1) Never seek to utilize any form of government health insurance (public optoin, medicare, medicaid, SSI).
2) I agree that hospitals or other medical providers have the right to refuse to provide service to myself and anyone else who does not have the ability to pull their own weight and pay for said services (including emergency room visits).
3) I agree to be legally bound to the terms of this agreement for the duration of my life without recourse against the government or any healthcare providers.
In return I ask that I be exempted from paying any and all taxes and fees to support such un American  government programs. I want to guarantee the freedom of choice in matters of health insurance coverage and services performed to myself and to others like me.