but you have to realize that the fix is changing health care provider compensation. The waste I saw in Medicare had nothing to do with government bureaucracy (they actually privatize a good deal of the work exactly as conservatives would hope) but instead had to do with the complicated compensation system revolving around those procedure codes.

Even though there's no turning down patients for the most part, no denial of care essentially, doctors and hospitals are still reimbursed through hugely complicated individual contracts with the state entity that are based on procedure and resources used.

So let's say we can reach agreement that Medicare needs to grossly simplify things in order to do a better job. Providers that sign up with them must agree to a simple annual salary. They must put in a minimum amount of hours to get full pay. In a complete national health care system providing care for all ages, that annual compensation will be high enough to be that doctor's entire salary. They can dump those 5 office billing specialists. If the government's backing all their business, they can probably cut way back on malpractice insurance. They can choose to work out of a national health facility and not have to be in charge of maintaining drugs and equipment.

However, if you just use Medicare as a test, many physicians wouldn't get enough of a customer base to have full-time employment. The annual salary may only be enough for a portion of what they need to make. If they still retain their private practice and get other compensation through the private insurance companies, they have to still retain their billing staff, their high malpractice premiums, their office and equipment.

I'm not averse to a test system but I'm not sure you'll see the real savings until the entire system is nationalized and of course my opinion is that it must be a complete single-payer system with annual salaries as the model for compensation. That's a tough thing to run as a hybrid. In many ways, despite the obvious chaos, it might just be best to bite the bullet and take the plunge.

I want to believe Tom, that your suggestion is true brainstorming but excuse me if I'm a little leery of your intentions based on your history and your disdain for government. There's a distinct possibility that you are hoping for a limited test because you know that will cut back the potential savings and it can be spun as a failure. I would hope that isn't your plan.

Art