The Republicans will have you believe that single payer will replace private health insurance. That is simply not true. If one wishes to have private insurance, then there is nothing to prevent a person from buying it. The single payer system will provide much-needed competition to the private insurance companies, thus bringing down costs in an otherwise unchallenged market. It will ensure that EVERYONE is covered and bring about a peace and tranquility to those now buried in holes they did not dig for themselves. And it will even save lives, as well as giving all people the reassurance that when they lose their jobs, they will not lose their health insurance.

There are none so blind as those who WON’T see and you can apply this wisdom to that nasty and selfish element in our society which does not want to give up one penny of their good fortune to help those in need, either via taxes or some other way. They will make the decidedly un-Christian argument that the sick and unemployed have made their own beds and must pay the consequences. How wonderful to live in a fairyland where disease, illness and unemployment have not yet touched their privileged lives.

No-one should resent good fortune, but to plead an argument that we should all help ourselves, when it is patently obvious that some of us cannot because of circumstance beyond our control, is just plain political hogwash.
Suzanne Langland

You are correct. Bills should clearly itemize the charges.

You are absolutely correct in your observation that there is some funny business in billing. The “fee schedule” is based on the relative value scale that Medicare uses. It is inherently The fee schedules for all procedures and levels of office visits are based on the Medicare relative value scale that is skewed towards higher reimbursement for procedure (like three little stitches) than evaluating and managing a patients condition. Those fee schedules are re-evaluated every five years in a process that, by law, is subcontracted to the AMA whose Reimbursement Update Commission meets behind close doors and is dominated by specialists, who do procedures. Need I say more?

As for “containing costs”… It’s our job to take care of peoples’ needs and, partly because of fear of liability, we have become intolerant of uncertainty and, therefor, quite prolific in the tests that we order to make sure we aren’t missing something. It’s hard to be concerned about constraining costs in that environment.

Now, you ask, how much should a doctor get paid? How much is too much is easier to identify than how much is enough. A number of the specialist expect to make mid-six figure incomes while primary care doctors make on the order of $170,000 to $200,000/year, less in some states like Oregon. I would say that $350,000/year should be enough but there are many specialists who believe they are worth, and earn, far more than that. As a group, physicians have lost perspective on how much money $350,000 is to the average person. I can safely state that virtually every doctor has someone (from the billing office) looking over his/her shoulder coaching them to maximally document and optimally code every chart so that “we don’t leave any money on the table.” For most of us, how much is enough is how much money is on the table. We are just human beings.

The reason the doctor quite reasonably dropped his charges have to do with cost shifting. We charge far more than what we expect to get paid, contractually, by insurance companies, Medicare, and Medicaid. If we charged less, we would get paid less. Sadly, self pay people see the bigger bill but only some doctors let people know, up front, they they would (should?) get a discount for paying cash promptly… just like the insurance companies.