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Last year my sister had suregery to remove a growth on her wrist. She dosent have any insurance so I picked up the bill for her (Long story she needs my help and better me than the Government). When the Doctor and the Anethsiologist found out I was paying cash they both cut their fees by 2/3's because they didnt have to deal with insurance. That explains it right there.

But when my sister in law was out of work and had no insurance, she encountered people who would not treat her at all, when she offered to pay out of pocket.

I suspect it was because they no longer had a blank-check opportunity to loot and plunder her coverage.

Yet, I know several physicians personally who walked away from their practices because they could no longer stand dealing with HMO paperwork.

Maybe some providers are better at gaming the system than others.

'Maybe some providers are better at gaming the system than others." That's definately true, I think. Here, both docs and dentists are enrolling ther practice with subscribers who pay $1500/yr.

I ordered this book and read it. It is a tentative first step. However, it does not begin to address how government controls the supply of docs and thus subsidizes them to be the highest earners while runnng inefficient cottage industy with poor accountability. We need major doses of competition and sunshine.

There are definitely physicians out there who 'game' the system, but the expenses of medicine go very far beyond physician fees. If you look at a standard bill from a hospitalization you will see that physician fees are a fraction of total costs. It's a complex mix of the costs of technology, malpractice and product insurance costs (built into just about everything you can imagine related to medicine, including drug costs), and what has become an unwieldy bureaucracy. From what I can tell from reading the summary, I think this book puts forth some good ideas.

Where did this occur?

We have high deductible catastrophic. We are never denied treatment. If a medical bill is too large for immediate payment, we have never been denied the ability to pay it off in installments at our own discretion, without interest penalties. Our dentist offers 10% discount for cash. I am not aware if we receive any discounts for being self-pay for medical procedures/exams/tests, etc, but the charges have seemed moderate, so far.

Locally, we are blessed with a large population of top-notch medical providers and being in rural Wisconsin, we have a large percentage of Medicare recipients and a fairly large population who need Medicaid. The last time I had to use the ER, I noticed that it was near empty on a summer Sunday afternoon. It can take 2 months to get an MD or DDS appointment for minor things, but emergencies are seen ASAP.Our physicians retire at 65 or older and I have not heard of any private practices shutting down because of malpractice costs, even though they operate under a lot of ridiculous rules, like needing a full-time radiological tech on premise when they only need to take X-rays perhaps 2-3xweek.

Are we just fortunate, here? We do have illegals who work in meat packing, ag and construction, but again, lately, we see way fewer of those even in Walmart. I know that at least one large ag operation self insures with a high deductible MSA for all its employees, as do several small manufacturers.

Factory pay here is $10-$14/hr w/benefits and even Walmart pays nearly $8 for part-time asociates and time-and-a-half for holidays. Our FP guys make around $160k/year +benefits and the large hospital practice pays their malpractice. Probably a lot less then they could make in an urban area, but the quality of life seems to make it worthwhile for them. We have at least two OB/GYNs, as well.