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.