> On average, 33 cents of every insurance dollar in the US goes to paperwork and paid negotiators on the doctor or insurance company side.
That's misleading, this is the percentage quoted for overall non-clinical costs. The better number you should be mentioning is billing and insurance related (BIR) expenditures which ranges from 3-15% depending on the setting you're talking about.
Note that a fixed fee schedule does not eliminate BIR expenditures, Medicare which works like what you're proposing is ~3.5% for BIR. Canadian provinces are in the 5-10% range.
> If hospitals and insurance companies established a standardized (regional) fixed price list for all procedures
Should procedures cost the same wherever you go? The quality of care is certainly not the same although everyone meets the minimum standard. e.g. cancer care at Stanford is higher quality than at a neighboring community hospital, should they not be allowed to charge more for it?
In any case that's the point of PPOs, the hospital/provider has pre-negotiated/accepted the insurer's fee schedule for the year. It's not negotiated on every visit.
> auto-approved everything
Does anywhere do this? How do you control for unnecessary/wasteful use of resources? Neither HMOs nor the public Canadian health system auto-approve everything.
HMOs like Kaiser appear to "auto-approve" but they control the referral and keep a check on their PCP resource utilization and referral rates. You can't just walk in and demand a spine MRI because you've had back pain for 2 days, if the PCP imaging rates deviate from what is expected they will be audited and/or disciplined by Kaiser.