I don't think #2 will work without reforming the system to incentivize that kind of behavior. My grandmother goes to the podiatrist to have him cut her toenails (diabetes). There's barely any risk of her doing it herself, but he charges $200 every week for this treatment to Medicare. With her supplemental insurance, she pays nothing for these visits out of pocket. Why wouldn't she go?
Interestingly, the trimming of toe nails can be abused with "up-coding" as "minor surgery". When I worked with a group investigating Medicare/Medicaid fraud, this procedure was a commonly abused (with up-coding).
The point being is that fraud is a significant problem, but it's not easily solvable.
Chicken/egg. I'm not sure reform is practical until consumers have the help necessary to shop / compare. Otherwise, you basically have a bunch of old, angry voters.
