Some of the most byzantine being the existing government health plans of Medicare, Medicaid and Tri-Care. This is one reason I don't have much faith in a single-payer plan saving much money – yes it will be easier having to deal with just one set of rules, but based on how the government does things now it will still a big pain in the butt (and expensive).

A true, streamlined single payer systems, with established policies and procedures to be followed will have instant and logn term savings from efficiencies that are neglected by large insurers, at least until they surpass the cost of doing business as usual. Remember Ed Norton's Fight Club insurance adjuster character's explanantion of cost? Litigation is an important component of accelerating this process to protect lives.

Insurers already ration care, as been established by other posters, there are acceptable guidelines and best practices for care that shouldn't be tied to profit margins. I think reports of 1% profit margins are a shell game with big insurers, hiding things like 25% administrative costs. Providers on the other hand can often barely stay in business due to the byzantine array of policies and billing procedures that they have to harness to deal with multiple pay sources.

You’re doing a good job of identifying problems with the current healthcare model and proposing modifications to alleviate those shortcomings.

One thing that hasn’t been discussed yet is what do people want the healthcare system of the future to look and act like?

Adilinesdad laid out a scenario, but how would he want the situation to be handled differently if he had the power to remake the system? Ron Beasley can’t get insurance, so what kind of system does he see as solving that problem, and if it is single payer, what drawbacks would there be?

It’s hard to plot a course if you don’t yet understand the destination. Once people agree on where the system should end up, the details tend to fall in place much easier.

Start with an easy scenario.

You wake up sick. You’ve had flu-like symptoms for a few days, but this morning you feel worse than you ever have. You know you should seek medical help.

What do you want to happen from that point on?

The facts are still the same: insurance companies' profits are quite in line with those of similarly sized companies in other industries. They're a tiny slice of the health care industry pie. If you were to refund them 100% to consumers, you wouldn't make a noticeable dent in anyone's bills.

I'm not sure how to respond to your bizarre last paragraph, which has no relationship to any position I've taken. My main point is that people can't afford medical care because it *costs too much*, not because insurance companies are evil. Simply nominating a more enthusiastic payer to cover increasingly outrageous bills is a foolish reform in that it doesn't grapple seriously with the underlying costs of providing the treatments. Single payer “fixes” the system in the same sense that one “fixes” the cat, leaving it less functional that it was before.

The point is the algorithms may not include rare or exotic tests or treatments that actually might be appropriate for the patient. In an effort to save money though the provider would be immune from lawsuits as long as he was following the accepted protocols.

Since the Democratic Party is heavily influenced by trial lawyers I doubt this proposal will gain much support.

Nice made up numbers. Check your facts, or better yet, check mine.

Just two days ago I sent you profits for the top four for profit orgs. Clever of you to ignore that. The distraction is the fraud perpetrated by insurance companies and their lobbying efforts to hamstring medicare.

You make it sound like these companies are the only thing holding back affordable health care. If they really are the cure-all you preach, why are 50 million uninsured, and why is the 2nd highest cause of bankruptcy medical costs?

“Providers are jammed between the financial pressure to do fewer tests and the lawsuit pressure to do more. So they do somewhere in between, but they have no good way to decide which to do.”

And thus providers are driven to find the middle ground between doing too much and doing too little. Seems to me that's how it should be. They do have a good way to decide which to do. Do what makes sense to treat the patient. If it turns out not to be enough, because you were dealing with a specific problem you had no way of anticipating, then the court should rule in your favor.

Providers are jammed between the financial pressure to do fewer tests and the lawsuit pressure to do more. So they do somewhere in between, but they have no good way to decide which to do. They probably end up doing more tests on louder people who are threatening lawsuits.

At this rate, quiet types will be weeded out of the gene pool. 100 years from now, we'll all be New Yorkers.

Every case is unique, so those guidelines would either have to be some oversimplified that they don't apply in some cases and would actually result in tests being denied which should be done. Or else they would be so complicated that doctors would just do the tests rather than bothering to understand the guidelines, to cover their butts.

In any case, I can only speak from my own experience, but I honestly don't think over testing is a problem (at least by my provider). My son suffered from severe pain for the first year of his life, and had several doctor's visits who blew it off as just “reflux”, before he was finally diagnosed with a rare disease after an endoscopy. Yes, those are expensive, but we had to jump through a lot of hoops to finally get one, and try multiple reflux medication multiple times (yes, the doctors actually told us to retry certain medicines even after they didn't work the first time). If we made the system even more averse to testing, my son might still be in severe pain (or worse) today. Maybe the cost would have been lower for everyone else, but a health care system that caters only to the “normal cases”, and to hell with everyone else, is not one I want to be a part of.

After my wife was having severe stomach pain several times a week for about a year, she finally decided to go to the doctor (yes, she waits way too long for those sorts of things). The doctor said she probably just had indigestion and she should eat more fiber. When she protested, indicating the severity of the pain and could not bear it any longer, the doctor said, “well, it couldn't be that bad or you would have come in sooner.” My wife asked to see a specialist, and her request was denied because it was her first visit to the doctor. Needless to say, after a few weeks of eating more fiber, she got to see the specialist and found out that she needs to take a medication which has helped (the specialist actually said eating more fiber was exactly the wrong thing for her, but that's another story). The general practice doctor basically had a rule that you can't see a specialist after just one visit, no matter how much pain you were in. I guess that makes sense, but it makes the point that there are already plenty of precautions in place to avoid abuse of the system.

I realize these are use anecdotal. Perhaps other health care providers are ordering pregnancy tests for males as standard procedure (just kidding, of course), but I just haven't seen that.