>>Do you really want to point at the victims of these thieves as the cause of the Medicare mess?

We both know that US healthcare costs are far higher than equivalent care elsewhere. Apart from overcharging, pre-ACA there was a serious issue with excessive payer profiteering behavior including rescission, exclusions and opportunistic caps; post-ACA there's a perverse incentive for cost inflation, since payer share is capped at 20% and 20% of $200 is better than 20% of only $150. Now the ACA is in trouble for the reason KG and I prophetically discussed last year, with any insurance scheme doomed if only riskiest punters sign up. Not enough healthy punters are signing up for a lot of ACA plans which seems to mean that personal mandate has failed. Humana now has pulled out which leaves some states with no plans.

Meanwhile did you see that CA now is talking about setting up its own single payer healthcare, including illegals? I know there's a lot of opposition to this- but as soon as you eliminate profit on the payer side, the perverse incentive for cost inflation turns into incentives to negotiate better rates and put a lid on excessive cost. As long as they put really good execs in charge, negotiating better rates from suppliers isn't as tough as imagined. Driving down costs also may require a rethink for recipients accustomed to seeing your apocryphal toenail clipping physician, but that's not a big deal surely.

One piece of advice I would give: as of last week, US physicians in specialties like Urogynae earn less per encounter than their counterparts somewhere like NZ where healthcare costs are a third of yours. In some specialties you could pay physicians nothing and your costs would decrease only 3%. So why target or demoralize key elements of your healthcare system without whom there's no hope of reining in costs. The smart move would be to pay nurses, doctors and other frontliners *more* in exchange for restoration of the old medical philosophy that parsimony is a moral obligation to stretch the health dollar. Those front-liners can soon identify overcharging or over-utilization, believe me, especially if it's carving into budgets they want to use on patient care. Of course you also need to shield them from ambulance-chasing lawyers or else you re-introduce the perverse incentive to tick every box on the test order form so you can't be accused of not investigating properly. Having last practiced when CT scans were a novelty, I can assure you that you do not need to order every possible test every time and in fact sleuthing (including talking with the patient since history is 80% of the diagnosis) and getting it right confirmed by one targeted test, is much more professionally satisfying than firing a blunderbuss and checking to see what got hit.