Who's most to blame for runaway health costs? Insurers or providers?

[many a good man]

Granted, insurers are nothing but a leech on the system sucking out money that goes to profits and high overhead without contributing to care. But there was a post recently (damn! can't find it) that made the point that providers are the ones forcing insurers to drive up costs year after year. The poster said that s/he sat in many meetings where these fees were negotiated and providers had the upper hand.

Can anybody shine any light on this topic? I've noticed that here on DU we typically like to ignore things that challenge our favorite assumptions (greedy insurers are the root of all evil) at the expense of getting to the root of problems. I assume insurers are the main problem but I want to make sure I'm right.

[John Q. Citizen]

1. When you have a single payer system you can negotiate fair fees with providers.

When there are multiple payers, then care providers are able to negotiate multiple fees with multiple payers and the cost drifts up wards.

Onee thing that could be addressed are the low fees for MDs or primary care providers and the sky high fees of specialists. They need to be balanced out somewhat.

There are those who say we need to get away from a fee for service system all together, although my guess is that most doctors prefer to be self imployed instead of hourly wagers or salaried.

[Cleita]

2. Dirty little secret, fees aren't fixed at the doctor's office.

I used to do billing and the fee charged to a private patient is different from what is charged to the insurance company, Medicare or Medicaid. The latter three is whatever the traffic will bear. So a doctor might get three different fees for the same procedure.

[John Q. Citizen]

3. Wow like airline tickets and hotel rooms.

[many a good man]

4. So single payer solves both problems in one fell swoop

I haven't heard of doctors in other countries with UHC complain about their pay very much, whether fee for service or salaried. Well, except for France where I think the doctors went on strike a few years ago (but you know the French!).

Out of control health care costs are the number one threat to the economic security of this country. Costs MUST be controlled at both the provider and insurer levels.

[John Q. Citizen]

5. and pharma and equipment utilization and charges.

[JimWis]

6. I recently discussed that question with a gal friend of mine who

works for the Mayo system. She told me a few stories about simple procedures where the doctor or hospital charged ridiculously high amounts. So I said to her - than you feel it is the doctors faults for these high costs - surprisingly, her reply was no. It is the insurance. The doctors have to charge these amounts to make up for insurance companies that will find a way to deny the charges, and also uninsured patients who end up not paying. Single payer would fix that problem.

[Cleita]

7. Not only that fees would be set by agreement between the government

and the health care providers on a regular basis like maybe every two years, so that everyone leaves happy. It's at the core of the barter system.