A few years ago, while attending a conference in Malaysia, I developed a sore throat that I was fairly sure was an infection, as I'm prone to them while traveling. I went to the hotel concierge at noon on Sunday and asked if there was any chance I could see a doctor that day, as I was leaving Monday morning and traveling all day, so if I didn't see a doctor immediately, I'd have to suffer two more days at least. She told me that there was a clinic nearby, which she proceeded to call to ensure that they were in fact open. I asked how late they were open, as the conference ended at 4:30. She gave me an odd look, and told me that she had just made an appointment for me, and that I could go on my lunch break, which lasted until 1:30. I was somewhat skeptical, but proceeded to hail a taxi, which drove me to the clinic in about ten minutes. The cabbie told me that cabs didn't come by the clinic very often, so if I wanted, he'd just wait outside so he could drive me back to the hotel. I felt like I had walked into some sort of alternative reality, but reluctantly agreed. I walked into the clinic, where the receptionist/nurse took me immediately to the doctor (no wait at all!). The doctor (who spoke fluent English) looked in my throat, diagnosed the infection, and prescribed me three medications, which the nurse then game me a few minutes later. No need to go to a pharmacy; no five pages of paperwork; no insurance billing information. The total cost for a last-minute, Sunday-afternoon appointment with an English speaking doctor, plus a week's worth of three different meds, was $17. Plus $10 for the round-trip cab fare. I made it back to the hotel before 1:00.

In case you're thinking that it was so cheap because Malaysia is a third-world cesspit, I'll point out that Malaysia is a rapidly growing economy with a per capita GDP of around $17,000/yr, which makes it poorer than the U.S., but on the same level as some Eastern European countries and only slightly less than poorer Western European countries like Portugal or Greece. Even if you triple the cost to account for the income difference, it's still a very reasonable $50.

By contrast, here in the good old U.S. of A, I have insurance. But getting a same-day or even same-week doctor's appointment is nearly impossible; forget about on Sunday! The co-pay for an office visit is $30 dollars, and the co-pay for medications is at least $15, and sometimes much higher. Even when you do get an appointment, the doctor is routinely running hours behind schedule. (The last two doctors I've been to have each been over two hours late). Now, I'm sure if you have cancer or some chronic condition, being insured in the U.S. is better than paying out of pocket in Malaysia. But for routine medical issues, I'll take Malaysia's system over America's any day.

but the real point is that you and I already are paying for this and the way we are paying is that we are paying for ER docs rather than primary care docs.

I think the only way to get govt out of it is to not provide free ER care and not provide MedicAid either... then we'd not be paying those costs.

If we need more primary care docs then just pay them an extra stipend when they go to Medicare School.. or similar incentives... we're probably going to see an increase in Physician assistants and Nurse Practitioners if the reimbursement rate is not advantageous to docs.. But even lower level providers can perform much of the basic screening and related work anyhow.

My Primary Care physician currently is in a practice with a Physician Assistant and the Assistant handles the lower-level cases and elevates them to the Primary care when needed.

it seems to work...

In 5 years, the health insurance industry/market will be radically warped, and healthcare delivery will be dramatically changed for the worse.

Using government to “solve” inefficiencies (caused by government) is the worst possible option. And using
a horrifically, poorly written piece of shit legislative sledgehammer (passed against majority will in the dead of night) to do it is about the worst thing you can do.

Obamascare literally is destroying the economy (along with idiotic hyperregulation), and will likely result in doctor/medical service relocation outside the US, and violence.

so the real question is how do you want to pay.

I've seen estimates that as much as $1000 a year is added to private insurance costs per person to pay for the uncompensated ER care for those who are uninsured.

if we could cut that cost in half by providing earlier intervention treatment..we'd oppose paying less ?