[jeremyt]

If only "pay for service" wasn't a recognized problem that we're currently trying to solve itself. It's almost as if when doctors are paid per procedure, they do a bunch of unnecessary procedures.

The idea that healthcare can be centrally managed comes from people assuming it's way simpler than it is.

[arcticbull]

Here's a good place to start. You know that demand in the US for a transparent fee schedule so people know what things cost at hospitals? Here's the list of every service administered in Ontario and exactly how much it costs: http://www.health.gov.on.ca/en/pro/programs/ohip/sob/

Those are in Canadian dollars by the way; yes, a specialist consult costs the province $100 (and you, $0).

It's hard to hear that you're trying to pre-solve cost problems you don't know you'll have if you were to switch to central management when the US is currently the most expensive healthcare system per capita by a lot (like, double), and is ranked 36th by the WHO. Far less expensive systems per capita are ranked dramatically higher even though they have a fixed fee schedule. Sure, there's room to improve, but maybe knock out the low-hanging fruit first.

Further, if that's too distasteful, there's other ways to make this work; the Swiss system forbids private insurers from making profit on the basic administration of healthcare, and caps individuals out of pocket expenses. I'm sure the insurers would find a way under such constraints.

[lozenge]

The ACA also demands insurers pay 85% of revenue in health care costs and caps out of pocket expenses...