The hidden costs for insurance companies are the costs the doctor's offices spend to meet their filing requirements. I have a small clinic with a total of 3 employees. One full time equivalent is totally due to accepting insurances - the paperwork and filing requirements - and, we don't get paid at reasonable levels to provide good health care. It makes it difficult to keep the doors open !

We could start by understanding how much our presuppostitions about what is going on are colored by our political predispositions and their corresponding rhetoric.

Let's take those "deep pockets", for example. My companion is totally disabled and has been so since 1980. Medicare pays primary and Medicaid pays secondary for her care. We recently calculated that her monthly Rx costs alone, at full retail, average $1100.

Medicaid (still the only payor of her prescriptions) actually pays between 10% and 40% of that depending on the drug, with an average of around 30% or $330 (exact figures are hard to come by since the Medicaid prices, and even whether a drug is covered at all change monthly (!) in Ohio). The rest is written off by the pharmacy.

Medicare and Medicaid between them generally pay no more than this 30% (and sometimes considerably less) for all her medical services, which average 1-2 doctor appointments per week with supplemental services, and with chronic health flares this can rise almost instantly to 3-4 visits a week for weeks at a time!

Virtually all of the surplus cost of this the providers have to write off!

What is the "just price" of all this? And how closely does it match what the Government pays? Heaven alone knows!

But I doubt short of running a complete "care mill", with considerable fraud on the side, that any provider could make a living seeing Medicare and Medicaid patients only.

Some deep pockets.

You're right. The complexity of medical billing doesn't help, either. It's another reason that there's no real market in health care.

It's not blockbuster stuff, but could be useful.

1. No reform will "heal health care" so long as physician salaries and hospital costs (the two largest cost components) rise without bounds
2. Government accounts for 50-60% of all health care spending.
3. There are no forces other than government that can control the rise in costs so long as government with its deep pockets is the largest purchaser of health care.

The health care system has gotten to the position it's in right now after 40 years of government mis-management. I wish I had good solutions that would solve the problem without pain. I don't.