Most folks who are fit and 21 just go without health insurance. If you've got a job and aren't contracting, then you usually get insurance through work.
If they're not in school, and they don't have their own job that provides health insurance, well...honestly, if they don't have a job that provides it, then they probably don't have a job that pays enough that they can afford to get it independently either. Most of my friends in that situation just gamble and try not to go to a doctor unless absolutely necessary. If they do have to...well, then they're going to be in some serious debt.
It's not a very good system, but it works for the people who have influence.