The medical system as it stands today, is also not setup to deal with you just paying out of pocket.  Years ago, I was out of work and had no insurance.  Sprained my ankle pretty badly, thought I broke it, so I went to the ER.  It took months just to get a bill I could pay.  They called me offering credit counseling BEFORE I had ever received a bill.  So, I asked for a bill, told them I would gladly pay it once I knew how much to pay.  This went on and on for close to 6 months.  How hard is it for them to ask me for money?  For me, this was quite a while ago, but I have friends who have had similar experiences in more recent memory.