An alternative is the "Medical IRA" thing (https://en.wikipedia.org/wiki/Medical_savings_account_(United_States) that Pres. Bush enabled (that and hydrogen cars the 2 good things he peddled?), which allows workers (usually younger ones) around $4k/yr in a tax free medical account, along with a major medical policy (usually a $10k deductible). Such plans force users to pay more out of pocket, but they're covered for major medical. They also serve to keep big Medical more honest since users "bargain" for services. As you said, most are just getting their annual checkup (so what?) and end-of-life care (the happy pills that makes your final days more bearable?). I'm not sure what employers offer workers with dependents for Medical IRAs but I suppose its a similar thing x # of dependents (since that saves the employer too)...at end of life the IRA is transferable to dependents and all the while you have incentives to be healthy (ie exercise, eat right, not smoke or drink, be nice to family) while big Medi-Pharma cannot feast upon your unwilling carcass.