You can't pay less for health care without paying less for health care. That means paying all the people who provide health care less. There's not enough money that goes out of the system to health insurance companies to make a dent in health care spending. Heck, not even a third of our health care spending is even in the private insurance system anymore.

There used to be an expat Brit, living in France, on the Fool METaR board. He talked about how the French have wrung the administrative overhead out of their system. Because there is one payer, there is no blizzard of different forms. When he checked out, after seeing his doc, the clerk would swipe his health insurance card, type in a few codes for what the doc did, and the payment would be in the doc's bank account, before he was out the door. He also talked about how the health system made sure facilities were not standing idle. Wait times were continuously monitored, and spending on additional facilities would not trigger until wait time reached a set level. Seems about the same in Canada. When Tim went in for his gall badder surgery, he was in the OR at something like 2 or 3 in the morning.

As someone said on this thread, there are lots of "rent seekers" trying to skim the cash flow. iirc, when Part D was enacted, it was specifically written to prohibit Medicare providing the coverage directly, so all the money went through the hands of private insurance companies and PBMs, where it could be skimmed.

Someone mentioned what doctors charge. They have facilities to pay for, and they have their own administrative overhead to deal will all the insurance company interactions. How much did they spend on education to be qualified? Cheap, or free, education would help a doc's balance sheet.

Western European countries have been working these systems for over 70 years. It should not be that hard to pick and choose the best practices to design a USian system....except...the money, and the influence it buys.

Steve....dreamer