There is nothing rude about paying for a meal. You worry entirely too much. I have paid with 1k notes, too many times to define, and that is using them to make meal purchases or items at the 7-Eleven or at a street vender, where if they don't for some reason have change, will ask the other venders to help the out. You will find there are certain machines that only give out 100 baht bills and that is a pain in the ass. Too many bills!
You are going to have a hard time convincing anyone the a Thai person couldn't do the job, especially when Thailand is 5th in the world in medical care.
If you are referring to getting the one year exit visa and leaving and coming back, before it expires, to get another year added on? I have seen posts saying that is correct, but I have not done it.
Elite Visa subscribers want you to think renewing annually is a big deal, but if you have a Thai friend or service help you it's not. Sure their is the cost of doing it but with a Thai friend it can be done very innexpensive and with a service still at less than a third of the cost of the Elite Visa. It's kind of like filing your taxes. Would you rather pay them 10 years of money up front at the highest rate or pay 1 year at a time and get the lowest rate? It's a personal preference.
I would doubt you will ever use a hot tub here, as it is never cool enough to enjoy. I have stayed in many hotels in Asia and have never seen a hot tub. Not saying there aren't any just that there are few customers that would want to use one. A Jacuzzi on the other hand might be quite relaxing.
Go back and retake the test. You can do it everyday until you pass. Also they have a book that they don't publish, but keep it at the test center and if you ask they will let you look at it before the test. I did because I was concerned about all the signage that is clearly way different than what is found in the US.
I have been traveling to Malaysia for years. That stamp is not a visa, it is tourism pass and allows you to stay up to 90 days. You can leave the country and return and get the same stamp again.