This is just a quick proposition.  It needs some fleshing out and discussion, and that's what makes TPM worth visiting, the discussion. We hear about the payment schedule of Medicare and how unfair it is, but we seldom talk about the payment schedule of the insurance companies, who set their own prices, reimbursing providers as they see fit and leaving the providers to write off the "loss" or bill the patient, who I will refrain from calling the customer.  Maybe we should call the patient the mark in this con game of insurance.  At any rate, what if the government simply paid the average of the fees paid by the insurance companies, thereby allowing the insurance companies to set the costs based on their own criteria  This would make the government a moderate in the game of insurance when it comes to paying the providers.  Some insurers would pay more, and some less.  If every provider paid the same, then so would the government insurance.  Now how that average was calculated might need some consideration.  Average all prices, or average of all services paid to allow a majority insure'rs quantities to adjust the average with an insurer who seldom provided that same service.

It seems this strategy could help separate the providers from the insurance, because right now, big medical providers and insurance appear to be bedfellows and strange ones at that.  But if the prices for services were related to the prices paid by insurance companies, then any objections  providers would have would need to be made versus the insurance companies rather then the government program  This proposition takes responsibility for prices out of the hands of the government, but still gives the government a fair price.  It would seem to me that the providers would rather argue with the government in this matter then private insurers.  I mean, how successful have they been in naming their own price for their own services?  Insurers have set the prices.  Insurers set the price and the premium deciding who pays them how much and how much they pay others.  It's really a great gig.  I want to buy a car like that.  I just go in and tell them, as I take the keys and drive away, that the "usual and customary" price for the car is $10,000, although the sticker says $17,000 and leave them no recourse from me other then to call my office and leave a message, or write a strongly worded letter.  But I digress.

Efficiencies with a government run program would still enable them to keep premiums down.  The government would not need marketing or exhorbitant CEO salaries, or shareholder profits, or a host of other necessities incumbent on private insurance.  So the program could be economical and related to free market prices, and I laugh as I think of that invisible hand helping consumers by keeping prices down.  Is it one of the "good hands" in the insurance world, I wonder?  At any rate, I think this idea can appear reasonable to the people and something the insurance companies might support or at least have no rational defense, although I do not think that would stop them from objecting.  But the providers might have to reconsider their alliance with the insurers, and it's the oldest strategy known to man, divide and conquer.  We could get a public option, government run program, and leave the providers and insurers to fight among themselves.