Harder to defraud for who? You wouldn't be paying directly. Your money would be locked in an account that you can't touch unless the shit hits the fan. In the meantime (might be a year, might be 30), your money is most certainly going to be securitized by whichever corporate entity is holding it, which is going to invest that money to pay for the cost of providing those accounts. (unless you're paradoxically suggesting we have HSA accounts that the government hold the accounts and pay for their administration with taxes?).
What the hell are you talking about? You'd pay directly every time you went for primary care with what would be for all intents and purposes a debit card on an HSA account?
You're just making things up at this point.