In this episode, I examine the growing issue of unpaid medical bills by foreign visitors in Japan—not from an emotional or nationalist perspective, but from the standpoint of institutional design. Most foreigners follow the rules, yet Japan’s healthcare system, built on the assumption of universal responsibility, struggles to handle short-term visitors who leave without paying. Emergency care prioritizes saving lives, while cost recovery often fails. This is not a moral failure of individuals, but a structural flaw in the system. Using personal overseas experience, I explore the tension between humanitarian values and sustainable rules—and why fairness requires clearer, enforceable制度 rather than vague kindness.