You can't in Austria - you can additionally get a private insurance, but it's by no means mandatory.
Although I pay most of my urgent stuff in cash, and get it back later (not everything), because otherwise I have to wait 3 months + for a simple scan :/
Oh yeah, definitely. The security net is great. And I get that for it to work, it needs to be paid for.
I think that the downwards movement is more based in the population aging though.
And the reason I hate it, is literally because there is no opt out at all. Hell, I'd use the public option if there were an opt out because it works well enough for me.
Although I pay most of my urgent stuff in cash, and get it back later (not everything), because otherwise I have to wait 3 months + for a simple scan :/