In the US, the system is overwhelmed in large part thanks to the financial side pushing for ever increasing patient loads and reduced staff. So nurses are saddled with more patients than they can safely take care of because an empty bed is lost profit. This has a cascade effect because staff are leaving the industry as a whole because of the understaffing, stress, and poor pay/life balance.
I don't know if the ACA has the same tax as your system does, but I know my state also has a tax penalty if you're not covered by insurance. The upside to this, though, is that the state offers insurance. It's not a great system (before you even get into the plague of issues with the finer points of the system), but it's better than just leaving people to fend for themselves.
Depends on whether you have an Android or iPhone for 99% of people. Or, they use an email account that their ISP provider created for them when they signed up.