Is that true? No. If the insurance company contract pays a flat amount for a procedure, that is the income--period. As the provider has already agreed to the haircut set by the insurance company(ies), prices can be reduced to that level from that provider.

I'm not sure what you're saying here. If the insurance company contract here in the U.S. provides a flat amount of $1,000 for a procedure here, and the single-payer system in an EU country provides a flat amount of $500 for a procedure there, then we're paying more money for the same quantity of health care services. It doesn't matter that the amount is set by the insurance company contract or Medicare or the EU country's Health Ministry. Since the amounts that are paid in the states are higher than those in all the other countries, we end up paying more for health care than they do. That's true in both the private insurance sector and the Medicare sector, since we pay about double the per capita expense than other countries for both people under 65 and over 65.