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To: bentway who wrote (199850)	5/3/2009 1:11:14 PM
From: neolib	Respond to of 306849

I think a graph of economy of scale would start to flatten pretty nicely once you are above 1M customers or so. No need to go all the way to 300M to reap those benefits. All the duplication of function by hundreds of insurance co's is useful because it provides competition and keeps everyone's pencil a little sharper. Strange as it may seem, multiple people scrambling for a living makes a more efficient system. Those who get fat and lazy eventually starve. The single payer system has no protection against a slow slide into incompetence. The fundamental problem in that regard right now is that there are significant impediments to shifting between insurance companies for the consumers. If you are sick already for example. Change that, and most the problem goes away. The issue of providers dealing with multiple insurers is a valid issue, but I think that can be dealt with by some other fundamental changes. The current system has focused on obtaining competitive advantages via club arrangements. This is crap. Make that illegal. Why should a doc get a different payment depending on the mechanism of payment? Why should the consumer be charged a different amount depending on the mechanism of payment (neglecting reasonable interest for time factors of course)? Neither the Doc nor the consumer should see that sort of discrimination, and the insurance companies should be wasting their time cooking up such scams. Multi-payer systems can still select a single default payment schedule just like a single payer would.