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You can buy insurance outside of your job, but it's very expensive. Sometimes it's hard to get too because most of the people who get it have chronic conditions that require medical care. There often isn't much "sharing of the costs" since most people have high costs.

I don't really know that people take better care of themselves to keep medical costs low. One thing, while there is a list of tests required to be covered by insurance (mammograms for example), most routine stuff has a copay that ranges all over the place in expense. So, if somebody thinks he _might_ have a funky looking mole that _might_ be cancer he's kind of encouraged to put off seeing a doctor because of the expense. Also, insurance will cover things like bariatic surgery, but they won't cover things like gym memberships. Just now insurance is starting to cover _some_ things related to quitting smoking, but they've been covering smoking related diseases the whole time. I guess what I'm saying is that there isn't a lot of financial motivation to keep things in check. (There are of course other reasons to try to stay healthy, but insurance/health care/financial stuff often isn't one of them.)