I've had a lot of family time in the hospital systems in a relatively well-managed part of the US. And, I worked in the 'back office' of a medical system a while ago. Talking to billing people, etc, I came to the conclusion that "reform" with existing vested interests is... not going to happen. I don't know what a _good_ solution is, but I can imagine the least painful way is to have a parallel universe of MDs with a wholly different billing, licensing, board-certification regime.

One interesting question is: why is one hospital's rate for procedure X different than another? how can providers work at different hospitals? The answer lies somewhere in the "it's a maze of subcontractor relationships", "it's a maze of one off insurance contracts"...

It's a very good example of why vertical integration beats subcontracting. :)