[gsmith]

Check out stand-alone facilities in Mexico. Several major cities have great facilities staffed by highly qualified doctors. They don’t accept insurance, but their rates are substantially less than for comparable facilities and services in the U.S.

[dr.antonatos]

I receive most of my major medical care in Panama. For instance, we recently had a baby there, and the total cost for everything, including a C-section, OB services, anesthesiology, assistants, medications, and a 3-day stay in a private OB suite, was approximately $6,000 out of pocket. We found the quality of care to be superior to that in the U.S., all at a fraction of the cost.

[dr.antonatos]

Government regulations, such as the Stark Law and the Affordable Care Act (ACA), limit physicians’ ability to own hospitals by prohibiting self-referrals and restricting the establishment or expansion of physician-owned hospitals participating in Medicare. These measures have shifted hospital ownership to large corporate entities. This shift has given rise to the corporate practice of medicine, where the financial priorities of health systems often focus on revenue generation rather than patient-centered care. Unfortunately this corporate model compromise care quality, reduce physician autonomy, and prioritize high-margin services over essential but less profitable ones. In addition, these large health systems are increasingly acquiring physician practices, and as of 2024, over 80% of doctors are employed within corporate practices. This trend is accelerating the decline of private practice, as government policies continue to cut physician compensation without adjusting for inflation, making independent practice financially unsustainable. As a result, private doctors are on the verge of extinction, raising concerns about the future of medicine and patient care quality.

[sailor]

There are ways around Stark, like making the physicians debt-holders, instead of equity-holders. I’m not sure what ACA did, but you are making my point for me, since a direct-pay hospital would not accept Medicare or big health plans. Ambulatory surgery centers, like Surgery Center of Oklahoma are showing that direct-pay for outpatient surgery is often cheaper through their direct-pay surgeons than through major-medical plans. Acute-care hospital pricing shenanigans are making an increasing number of Americans willing to look for, and pay more for, predictable alternatives.