I don't understand your argument. Even on insurance, a lot of Americans routinely ignore preventive care because of the hassles, overhead and out of pocket costs even after insurance. Unless you are lucky to have great insurance by your employer. The point is that insurance should NOT be involved in preventive care. It should be a direct free market cash exchange b/w just 2 parties. Patient and doctor. That's it. NO premiums, no copays, no coinsurance, no claim paperwork, no calling insurance companies to figure out the charges etc etc and most importantly, no dependency on having a job to be able to afford going to a doctor even for preventive care.

You will see a lot of people using the (expensive) ER to treat their health issues. The reason they are there in the first place is that they couldn't pay for preventative care, so naturally they can't pay for the ER either. As a society when someone who can't pay ends up in the ER we have two options: treat them anyways, or turn them away.

Yes but that is due to our current expensive healthcare system where out of pocket costs are just some insane arbritrary number. Most hospitals cannot even tell you a "cash" price until you really push. My whole point is that it is all so expensive BECAUSE of insurance. If insurance was not involved in preventive care for example, all hospitals and doctors would have to compete on cash price and that would lower the out of pocket costs significantly. I bet less people will need to got ER because now they don't need to pay $10,000 for a doctor visit.

Even if a check up were $20 what I've described above would happen.

And then even fewer people would use it.

BTW, there's no out of pocket cost for preventive care for those with insurance in the US. There hasn't been since the Affordable Care Act became effective.

No one is saying to ignore routine and preventable care. We’re just observing that you can’t use insurance to lower the cost of it, in aggregate.

yes, and if routine procedures cost money, then people won't do them until they are emergencies. Why? Many people feel that they "shouldn't" "have to" spend money on those things.