Hmmm! Sduuuude, I think you might be missing the point here, or are just splitting hairs. Nobody’s talking about killing people. Health care is about keeping people alive …unless you are referring to the death wards:)
Well, if they voluntarily decide it, they also deem it. To deem is not to enforce. You’re splitting hairs.
The reason the costs are so high is that profit comes before right, shareholders before policy holders, greed before restraint, incompetence before efficiency. You can say the government indirectly has a hand in influencing everything, but that doesn’t makes it the main culprit, unless that is, it had the opportunity to make something right and failed to do, as is the danger in this case.
I don’t follow your argument about punishing people for not upholding their moral duty. The punishment comes from not educating people as to the facts, and therefore denying them the right to make those proper, or ‘moral’ choices in the first place. I use moral in a general utilitarian sense, and convey no religious overtones. We practice morality in the tiniest of social norms, which don’t necessarily conform to any written creed.