While private insurance companies have to negotiate individually for the rates they pay for procedures within their networks, Medicare handles that function by a Congressional mandate as to what prices will be paid to providers (presumably along with a prohibition on doctors refusing to work for payment which doesn't cover their costs of performing some services). When Medicare rates force providers to operate at a loss, the difference is made up by jacking up rates to private insurance some, and to the uninsured even more. The U.S. medical care system effectively subsidises proce controls in other countries through a similar chain reaction.

Bullshit. No doctor has to take medicare patients. They do so because they turn a profit. While they may lose money on some procedures, they make money over all. They just can't make as much money as they can from privately insured patients. The way that many countries hold costs down is to effectively reduce doctor's profits. At the same time, they mandate standards of care to maintain quality.

We've been trained in this country to believe that only private insurance can deliver good medical care. The health care insurance industry is one of the most powerful organizations in the nation. But, the fact is that we pay more per capita for health care than any other industrialized nation in the world. Further, the health care we get for that money is the worst in the industrialized world.

the unpublicized facts about insurance companies and allowed charges are these: what a physician or hospital or other care-giver charges is not limited. what they are reimbursed is set by the insurance companies and amounts to only a small percentage of what the charge is. this benefits both the doctor and the insurance company in the following ways; for the doctor, say he charges 1000 for a procedure. the insurance company allows only 500. the patients co-pay is 20% of the original charge. the doctor collects 300 from the insurance company, 200 from the paitient and writes the other 500 off as an operating loss.

the insurance company benefits because they don't pay the full charge, while still collecting those premiums from the patient.

the loser is the patient because not only is he paying the premium, but his is paying a co-pay too. if, as in the case of my daughter, the paitent is paying 230/mo for high deductible/high co-pay. if they have only the one $1000 health problem during the year, it actually costs them nearly $3000.

No doctor has to take Medicare, and a lot of them are refusing to see Medicare patients because they are a money losing business line. It gets trickier when the Medicare patient shows up at the ER and no physician will admit him or follow him up in the office--a "no doc" call. Since you have to agree to see ER patients to keep your hospital privileges, the doc must see that patient for free, take care of the acute process and then drops that patient like the proverbial hot potato. A lot of us feel like it is our civic duty to care for Medicare, Medicaid, uninsured--but doctors offices and hospitals are businesses, and they have to stay solvent. As for making less money--there comes a tipping point when it is not worth going into debt 100K (average debt for a med school grad, today) spending 4 years of your life in medical school, another 4 to 9 years in residency, working 80 plus hours a week during your twenties and thirties. There are only so many Albert Schweitzers in the world, and when you can make more money with less effort in the business world, you're going to have problems getting quality people to go into medicine. Or would you like the guy who struggled to pass chemistry to be your doctor?

A little math lesson--doctors fees account for about 12% of the health care dollar. Average doctor's office overhead is about 50%--so about 6% of the health care premium ends up in the doctor's hand. If every doctor took a 50% pay cut tomorrow, you'd save about 3 or 4 months of health care inflation. It ain't the rich doctors, though that may play well for the class warfare people. Canadian doctors make about 2/3 of what their US counter parts do, with almost no malpractice exposure.

The problem is that the US leads the world in life expectancy AFTER age 80. Other health care systems don't care for their old people--it is virtually impossible to get a coronary bypass in the UK if you're over 65, the Swedes don't treat prostate cancer (a disease largely of old men). I forget the statistic exactly but something like a third of the health care dollar is spent in the last month of life. Want to save some bucks--take everybody over 75 OFF Medicare and have them pay for their own insurance and health care. Suddenly, when Grandpa has a stroke and to pay for his clot busters means the family farm gets sold, many people will think, "Well, Pops had a good life, maybe its his time now."

As for quality being bad here in the US--ask your self why Canadians who can, routinely cross the border for care here in the US? Maybe its because they can get high quality care, quickly here.