as a result they spend one-sixth of what we spend per capita
I am reasonalby sure you are way off here Crash. I'm too lazy to look the numbers up but IIRC we spend about 70 or 80% of the percentage of GNP that you do and cover everyone instead of much fewer than everyone and offer care that is about equivalent in quality.
However, the discussion about imposing a user fee here to discourage "careless" use produced a discussion with my bro the doc. He agrees with all the rest of your thesis. It is indeed, he says, better to catch things early. On top of that he says that the amount of "careless" use is not so great as to be a real problem. His judgement is that a fee would cost the system more than it would save.