Well, in theory this is how insurance is supposed to work, and is how it works in other fields. The general idea of insurance is risk management: I have a huge unpredictable risk which worries me, so I transform it into a small, predictable risk by purchasing insurance.

And, true to form, with other types of insurance I pay "routine" types of costs myself; for example, I have auto insurance, but I don't expect it to pay for a tank of gas or an oil change. I pay those myself, and have the insurance available for things like accidents, which are unpredictable and far too expensive for me to pay for all in one go.

And yet... health insurance tends overwhelmingly to pay for predictable routine treatments (yearly checkups, for example) while balking at paying for precisely the sorts of large unpredictable costs it's meant to help manage. How'd we end up with that system?

Well, first of all, many health insurance plans don't cover routine care (annual physicals, etc.).

Second of all, those plans that do cover routine care generally do so under the theory that, by paying a small amount of money for routine care, they're avoiding paying much more down the road when the cheap problems that would have been caught at a routine physical turn into big, expensive problems.

Increasingly, health insurance plans cover routine care under the banner of "wellness" (there's a reason why there are specialized procedure codes to identify them). Unfortunately, they often take the form of "sure, we'll cover that prostate screening, but if it turns out you actually have cancer, um, tough luck."

That's nice until you try to obtain catastrophic coverage and are declined despite a lack of any current or chronic medical condition. It also fails to account for things like the fact that an MRI costs $150 in Japan and $600 in a "cheap" clinic in the US.

Funny, the Canadians I know don't go across the border to the US for dental services. I think you're really commenting on the inefficiency of the japanese system more than anything else. No arguments from me on that, but other countries are much, much more efficient.

Anyway, I don't think the average person has the option of venue-shopping between two countries, one in which he has nationalised health insurance, according to preference.