Elective surgeries, like plastic surgery and lasik for eyes, are affordable for many people, because they don't take insurance. Those docs make a good living. There are enough routine procedures that I can see where cash only practices will become more common, especially with Obamacare and the high deductibles.
A lot of elective surgery like cosmetic procedures and LASIK are paid for with credit. There’s a company that offers credit for these non-necessary surgeries (can’t recall the name of this but I’ve seen their brochures).
We could reduce the cost of doctors’ office visits if doctors didn’t have to pay so much for malpractice insurance, but there are other operating expenses of a practice: rent, equipment, staff salaries, waste disposal charges, utilities, taxes, workers’ comp/unemployment, TAXES, supplies, CME, etc. I try all day to find ways to minimize the ceaseless expenses. A doctor who spends twenty minutes with a patient can’t keep his practice going if he accepts ten dollars for that service, or thirty dollars an hour. He is paying his staff (together) more than that thirty bucks an hour.
The hard truth is that many patients, especially the elderly and those of humble means, won’t come at all if they have to pay out of pocket, because there is nothing in their pockets now. Many Freepers who talk about paying out of pocket must be fairly prosperous and have a lot in savings, but these days most of us don’t.
When my son had a serious blow to the head four years ago, his symptoms mandated first a CT scan, then an MRI later. The charges were below the level of the deductible typical for catastrophic care coverage, but were orders of magnitude more than I had in the checking account. I could not have paid for these procedures and subsequent care and subsequent necessary care without the excellent insurance he had.