Agreed on all points.

I would add that, in my experience, Japan has a culture that is based upon honor/duty/shame, and the society is homogenous, largely. So abusing the system (any system - transport, etc.) is almost unthinkable.

In contrast, the USA is ethnically diverse, the culture of moving around has broken the link between people and their clan/tribe/neighborhood, and criminality is glorified. So don't count on any of that "I won't do this because what will Grammaw think" idea modulating actions.

You may abandon your body, but never your sacred honor. - Musashi-san

I realize the modern Japanese people are "no Musashi-san(s)". Most of them anyway. But still in some aspects, these ideas go to the bone.

P.S. The Chinese have a culture that glorifies cheating the "lao why"/gaijin. And as you know they love to hate the Japanese, which to my eye is mostly jealousy but if they need a reason they'll bring up Manchuria. So going over to Japan to steal medical services would be right up their street. They do it in the USA as well, I am guessing.

As for the tort reform issues in the USA: "First thing we do, let's kill all the lawyers." - Shakespeare, Henry VI.