My wife is Manager of Budget and Reimbursement at a hospital, meaning that she budgets income and expenses (duh) as well as securing reimbursement from Medicare and Medicaid (which together make up the 800-lb gorilla that dictates how the medical system works), and other governmental programs. So she's got probably a better understanding of this than anyone. This is a weekly topic of conversation in my home.

There's a lot that could be done to make hospitals more efficient. My wife's is very management top-heavy, with as many VPs as a bank. And each of these VPs has their own secretary (who has secretaries anymore?).

On the other hand, much of the waste is either directly required by the governmental agencies, or the unintended consequences of those regulations.

It's well known that Medicare/Medicaid pay below the actual cost. Other big insurance companies get good rates, but normally not that good. Somebody has to make up for the shortfall, and obviously it's not going to be the big buyers that have negotiating power. The cost controls by Medicare cause prices to rise for the rest of us. If the government program gets larger due to individual payers joining on, there won't be even that pressure release, and governmental prices will have to rise.

Beyond that, it's been observed that we get far too many tests, more than are medically necessary. In many cases these are caused by Medicare regulation. For example, it was found that many patients get urinary tract infections at the hospital, so Medicare says they won't cover those costs unless the hospital can show that the patient had the UTI prior to admission. So it's not hard to guess what happens now. Everybody gets a test for UTI upon admission, since the cost of that testing is lower than the potential lost revenue from Medicare refusing to pay for treating the pre-existing UTIs.

Expanding the government's influence over healthcare isn't going to solve any problems, and it will exacerbate many of them.

Providing some separate body offering a "public option" is not a compromise that will satisfy both sides. It still contains the ingredients necessary to cause the "crowding out" of private insurance. This is what those opposed to the public option are afraid of, and Mr. Tevis's proposal does nothing (so far as the article mentions) to address that.

Wait a second, granted you may not have expected to be charged $700, but why have a doctor do something so simple? Why not just do it yourself or have a friend with tweezers do it?

How does any of this address the adverse selection problem? Many nations joining the alliance doesn't change the fundamental problem.