[chimeracoder]

> Before, or while. If the health agency is the final player stuck with the bill, you can bet there will be a strong push and leverage) to contain costs.

Not really - in fact, the current pricing situation is exacerbated by Medicare, not alleviated by it.

Medicare sets its reimbursement rates at whatever level it decides to pay (there isn't really any "negotiation" that happens), and providers are required, by law, to charge insurers and uninsured patients more than what Medicare pays. Unsurprisingly, this results in Medicare paying rates that are below COGS (and therefore literally unsustainable), and private insurers and uninsured patients make up for the difference.

The situation is so bad that Medicare has not one but two special programs to compensate providers who mostly or exclusively treat Medicare patients, because otherwise they would literally go out of business because they couldn't pay for their supplies, let alone rent and staff wages.