> I don't see why that stuff should be "free" for most people

I do. Having a healthy population benefits me. Having people immunised, cared for and well keeps me healthier and safer. Having people lose homes and jobs and potentially their lives because they can’t afford healthcare is not something I support.

There are actually tons of studies that show preventive healthcare reduces spend later on. For instance, if you pay for someone's routine checkup you might catch a heart issue or cancer early. Both insurance companies and the government (Medicaid/Medicare) would save money by paying for preventative care.

Study by the NIH: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5296930/

An HSA doesn't mean that you don't have preventative care. I have a high deductible plan plus HSA and there are things like annual checkups covered without going into deductible.

So about those.

I started with a new doctor after finally getting insurance a few years back. I told them I needed to come in for my annual check-up, and came in with a list of the things that had been bothering me and that I hadn't been able to get looked at (this is common for people who have not had healthcare access). The doctor spent 15 minutes with me, doing the bare minimum of setting up outside testing/imaging - as in, basically no guidance that day - and then coded it as a 45-minute, in-depth consultation ("because of the number of issues addressed"). $250. Before any tests or treatment. For reference, that was about 1% of my annual take-home. For a lot of you, that's like paying a grand or more just for your doctor to direct you elsewhere.

So, yeah, certain things are "covered." But the structure of our healthcare system forces our clinics and hospitals to operate like many other American businesses, which is "in a predatorial manner."

You went for a preventative check, and asked for a bunch of issues to be addressed and you’re surprised it cost you money?

What, exactly, is a preventative check, if not a discussion with your GP about your current physiological status? Given the time described (15 minutes), and the lack of immediate diagnostics, it sounds exactly like what I would expect from a check-in with my doctor here in Canada. The only other option I could see counting as a preventative check is a physical, which would be more involved than what was described.

It’s a matter of billing. A preventive visit does a set of screening and evaluation of results.

If you say “my knee hurts lately”, then that’s separate as the physician will do an evaluation that is separate from a routine physical.

And it’s not just the US. I have family in Canada and they were told maximum of 2 complaints can be addressed as they can only bill for a certain amount of time. Beyond that the doctor is working for free. Another separate appointment is needed.

So, yes, this is the problem. Healthcare should not be a business. It should be obvious that people who have been denied access before will come in to their first visit with multiple concerns, and the system should be accommodating to that without a massive "onboarding" fee. After all, it's not their fault that previous incarnations of said system did not supply care adequately.

If you view a person and their health in a holistic manner, you can't just say, "Well, I've got you set up to check for diabetes and Crohn's, but if you want me to consider that mole then you'll have to pay me another $300 and/or wait a few weeks until I'm not so booked."

My point was that "free preventative care" is not a panacea. Any time a doctor is incentivized to turn that visit into a money-maker, they'll gladly attempt to. And that's wrong.

So you’re against how universal care is setup in Canada? Each visit has a billing code for a certain amount of work. If you brought up other issues you’d be told to make another appointment.

Of course not. Canada's healthcare system is not, at the point-of-care, a business. Whatever business arrangement that exists is between the government and providers, not me and my doctor, so the latter relationship is not directly constrained by economic concerns, as is the case here in the US. If that appointment had taken place in Canada - and let's be clear first that it would not have, as I would have been insured unconditionally since birth and able to deal with each issue as it arose - the doctor would have either helped set up a treatment plan then and there, or she would have let me know that it would require another visit or two to go over everything, as here.

The difference is that I would not personally be out 1-3 weeks worth of food money for each visit, just establishing my baseline. In neither case would what happened be a "matter of billing" because I would never receive a bill.

It’s the same issue of billing for the doctor in Canada as the US.

The doctor gets paid $X for a preventive visit. If you start adding things on that will be flagged to ensure doctor get paid more, typically through additional billing codes.

The original comment was “why do I get billed more when I bring up issues during a preventative visit”?

That’s why.

Universal Healthcare systems can and do provide a significantly better coverage and vastly more cost efficient system. What you just said is selfish healthcare provision, look out for yourself and to heck with everyone else.

You have no empathy for people who can never afford ridiculous health care systems in private systems. This optimises the failed "rugged individual" philosophy that has only lead to ruin.