The whole concept of health insurance is flawed. Contract to pay $x when I die? Easy. Contract to pay auto accident damages? Not too hard.
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In other words, we'll always have some misalignment of incentives, but we need people to refuse to defect.
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Saying "we need to punish defectors more" in this case doesn't work that well because even finding and punishing defection has high costs
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Example: doctor decides to perform procedure of questionable value that he wouldn't perform on himself (but it works sometimes)
End of conversation
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Let's find what percentage of the Japanese govt budget devoted to incarceration and compare to USA/Europe. Immigration tough there
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Health care + Egalitarianism = High costs. Everyone believes they're entitled to the latest tech ($$$) in health care.
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This is why people rejected rational health insurance which would pay for emergencies only. They feel entitled to care at all times.
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If you want a state funded safety net, the best solution is a voucher system. That way you get market competition.
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