Ah! Yes that could work, but I have 2 issues with this:

I feel we'd need something with a precise audit trail that doesn't involve people self-doxxing their medical issues. I know many good, morally grounded physicians and specialists that aren't in it for the gains, maybe there ought to be a role for them? Augmented with proper expert systems, maybe? Idk.

For me personally, the problem starts with too many people, including many my age (Gen X), are expecting government to basically fix everything for them, because they voted so now fix my shit. But, as you say, the problem is often that government policy actually incentivizes much of what is wrong today, so "more government" isn't going to fix it, and "different people in government" is unlikely to either. But you or I can't make people let go of that idea, they'll have to do it themselves - I've decided long ago that all I can do is free myself from it, talk to people about it, but this won't be fixed in my lifetime. ²

I didn't see it like this in my early 20s either. I've learned a lot since.

Or competing for results! The main issue may be the protection under the law, that's something that RFK iirc wanted to do something about.