Opposites ends of the spectrum, you pay directly but get too much treatment and we pay indirectly and get treatment eventually, I suppose the one benefit of your system is that people don't just turn up with a cough, a splinter or the sick kid who is running round the waiting room causing mayhem, it makes them think rather than just turn up and overload the system. The one advantage of your system is that you must get more choice and unlike our NHS they are not guaranteed customers.
Exactly right - too much treatment. that's the system's incentive here. We still do have waiting rooms here with non-payers, but the insured folks have now gotten a pretty robust setup of walk in places.
Uninsured folks with no money aren't too worried about the cost of an ER admission. The hospitals, at least here, can't make them pay at the point of service in the ER whereas non-ER walk-ins can refuse service for non-payers.
For me, copay for using the ER as point of service is $300. To use a walk-in care center is $25. if you have a true emergency, then the point of service copay at ER is $0. I have been to the ER exactly once in 20 years - metal in the eye, large hospital here. it was late at night and filled with weirdos in the city, but the hospital had two dedicated rooms for eye emergencies and I was back out in an hour. that was before the rise of walk-in centers, and the copay back then was only $50.
With the structure change now, if you have a simple break, the walk-in centers will X-ray and set it. If it's more complicated, they'll send you to the ER, and you'll be admitted for treatment rather than just seen quickly for outpatient (admission is the trigger that makes the cost go to $0).
The same overall outcomes could be had here for half the cost, but not the convenience. So I think we're paying double for convenience. I've gone to asking my dr. when they suggest something if the same outcome is had by waiting longer to see if anything is needed in the first place, and that to me is convenience. Not running all over the place fixing a problem that really isn't treated better by over-utilizing.
Something probably needs to change there. Something definitely needs to change here - both in different directions.
Once you're on Medicare here (65), life is pretty easy as far as cost goes, though. A couple of hundred bucks a month for coverage cost (instead of more than a thousand for an uninsured at 64 to go to the market and buy coverage) and you have no exposure to any catastrophic anything. Once in a while, people get stupid here and refuse to pay the medicare copay or enroll in anything that uses medicare, and the result is ruinous. It's rare here, though, and done only by the odd person who is exceptionally stupid.
The trouble with the idea that Medicare extended downward would cover everyone is that the health system is covered by the insured payers and Medicare can dictate paying less than the cost of actual care to health systems - who make up the difference with insured and cash payers.