1. People who are not taking care of themselves should get less money.
-If you have a condition that requires you to maintain a certain sort of diet, quit smoking or get a certain amount of exercise, you have X amount of time to meet these requirements. If you do not meet these requirements and your doctor doesn't sign a medical waiver* for you, then the percentage of treatment the government will pay for on that condition starts to taper off. Once you meet the requirements, it jumps back up to its previous level.
It should be noted that this proposal is not saying you can't smoke, it is saying that if you don't quit under doctor's orders you might have to pay for your own healthcare for smoking related illnesses. Yes, it's kinda Nanny State, but I don't see it as less so than government-sponsored healthcare in the first place.
-The Government should collect data on how much it costs to treat the average person who was in a car accident and wearing their seatbelt on a hospital-by-hospital basis. Those who were in car accidents and not wearing their seatbelts will be covered for the amount that the government paid the average seatbelt-wearer at their hospital and beyond that are on their own. This could be applied to other stuff, but seatbelt-wearing is the most straightforward.
2. The "I'm ready" form.
A patient may at any time request a simple "I'm ready form" that all hospitals will keep around. After they have signed that form, no treatment will be covered by the government excepting pain relief. If said patient is at a hospital that is committed to fighting and fighting for patients' lives and putting their patients through operations and such to extend life by small amounts of time, they do so at their own expense once the form is signed. "No, wait I'm not" forms rescinding the previous forms would, of course, also be available.
The last two people I've known well who died eventually got to where they wanted to give up and go die at home. Both of them got their wishes because they had forceful personalities and supportive families. We might as well have the form for those people who have neither, but have the same wish. (Item: Most of the rise in healthcare costs has been from Medicare. One third of Medicare bills are from patients who live for less than two years after the treatment.)
I can see lots of disadvantages to these ideas, but I can see advantages too. Comments?
*Some people in wheelchairs, for example, are skinny. But many are not because it's hard to maintain a healthy weight when you don't even walk. If losing weight is a requirement and someone in a wheelchair is having trouble doing that, I'm willing to exempt them if their doctor is.