Because forcing people to buy insurance does not solve the problem you describe. 1) Insurance policies exclude pre-existing conditions or anything related to them. And that is what any insured person is most likely to get treatment for. So, in that case, all the requirement for insurance does is displace money to an insurance company that could otherwise be used to pay for treatment. 2) I have never met anybody in Thailand who did not pay for their medical treatment. Thai hospitals will not treat you unless you pay for treatment up front. 3) I believe it was only a couple of months ago that the Thai government added a fee on to aircraft arrivals. This 500 baht fee they said was so Thailand could recover the costs of treating tourists without insurance or sufficient funds. Now, they want to add the scam insurance in addition to the 500 baht fee. 4) Having the required Thai insurance doesn't actually insure anything. A couple of weeks ago, when too many people were filing claims for Covid policies, one insurance company just decided to up and quit and not pay. So much for hospitals getting their money. The policy holder/victim is right back to being forced to pay again--minus the money wasted on insurance. 5) The only thing this requirement will do is remove the amount of money retirees currently have to pay their medical bills. Otherwise the situation remains as it is, except of course many people will be aged out of being able to acquire any insurance, no matter the cost. 6) And nobody is going to be able to skip out on their medical debts. Immigration has all your residential and banking information. Nobody is going to get away with anything.