It is called a gasoline tax. The more gasoline you use the more tax you pay. The lighter vehicles that use less gas also damage the roads less.

they have a robotic fire brigade pipe band.

YES!

...Americans that can afford it just go to Brazil or India or Israel or ??? for a "medical vacation" and come back with dollars spent in other countries. Everything that is regulated out of ignorance and/or greed is still available - the drug companies are multi-nationals that are just getting paid in a different currency. Or, maybe I am just too cynical.