True, and to be honest any system that relies on people not taking advantage of it will ultimately fail. If only people could be relied upon to not exaggerate their symptoms to be seen first, to not go to the doctor with a headache for no reason other than to avoid having to pay a couple of bucks for an aspirin (this happened a lot in the UK, when prescription charges were abolished) and the like, then an ideal system could be set up. But, as you say, as soon as you need means-testing you need another layer of bureaucracy to manage it and you create another whole host of incentives for people to either not look after themselves or to simply lie about their means.