Here's wikipedia's entry on Hillarycare, anyone wants a refresher.  This summary line: It proposed the establishment of corporate "regional alliances" of health providers to be subject to a fee-for-service schedule.suggests to me a situation starting out like regulated utilities, where few would have lost jobs right away. And there's the fee-for-service thing which makes Harry & Louise out to be liars. But I don't know for sure and I'm not that interested in reading up on it. I'm more interested in spending my time delving more into the reality of what we have now and how it's going to change our system, whether intended change or not. (I notice wikipedia requesting someone do expansion, so there are others out there who feel like me and don't want to do homework on it! )

Here's a example of a left-sider that likes fee-for-service, Peter. Someone like Michael Maiello doesn't see why if he can't have his single payer insurance with a nationwide network of providers, he can't at least still have fee-for-service freedom like many retired folks do now.

I have a suspicion if you asked him how we should pay for that, he would say the richest should pay higher taxes to pay for it. I also have a suspicion he's not stupid about single payer systems and knows that single payer would include long waiting lists for the best providers and alternative treatments and that he would be willing to deal with that. He's also an experienced financial writer so I would really be surprised if he didn't understand what fee-for-service freedom means as regards costs going up. The comparison many make is with single payer, which Medicare is in design, not with private insurance.  Many want Medicare in its fee-for-service style, not reformed with bundling or whatever, for everyone.

What they like about Medicare is...

• No matter how sick you are, you can't be turned down.

• Your benefits aren't capped...you get it until "the end."

• Your premiums don't rise (that much). IOW, it remains affordable.

• You can't get kicked off the plan.

• What they don't like about private insurance is that none of these things have been true up until now. You could get turned down. You could become uninsurable. Your premiums keep rising. You could get kicked if you spent too much.

• Also, but somewhat less frequently mentioned, is curtailment of choice through in and out of network categories. In my experience, there have been "plenty" of docs who took my insurance, just never the ones I was going to and liked. That was probably silly on my part, and I probably wasted a lot of money on out of network people when I should've just switched to someone in-network.

• Medicare as it is now also does not give you infinite choice; it gives you a more or less infinite ability to spend money. As you say, there are many doctors, often the better ones, who don't take Medicare. And many, I hear, are dropping it. Until the government starts hiring all the providers, providers will be free to take or not take any form of payment they like. That ain't choice with a Big C in my book.

• If you read what he says, bundling is not only a payment method, but a way of organizing the work so that the entire team is focused on your health, not on racking up procedures. The goal is to heal you, and they do whatever has to be done to do that. Though not mentioned here, there is also the idea of evidence-based medicine that often goes along with this idea and is, in fact, part of ACA (though not huge). Which is to say a focus on using treatments that have been scientifically proven to work. If you can eliminate ineffective treatments and only use the ones that work best, then you may save money and, more importantly, do a better job of healing the patient.

• Personal anecdote. Some years ago, I was working with some "cutting edge" nurses, and they introduced me to the idea of evidence-based medicine. I said, "Uh, I thought all treatments were used because they had been proven to work. Scientifically." No, apparently not. Many treatments are used as a matter of...how to put it?...custom...or practice. They've been handed down from doctor to doctor, and every doctor receives them from older doctors in whom they have complete confidence, and so it goes. But if put to the test, these treatments might be shown to be ineffective, or less effective than thought, or less effective than an alternative.

Since doctors, under bundling, get paid for healing the patient and not for running tests, they have an incentive to do what will heal you and not waste time and money with stuff that hasn't passed the test.

Here's what Zeke says on bundling (below). I don't see anything here that necessarily entails an undue loss of choice..which exists in Medicare anyway...except maybe we'd no longer have the choice to pursue a lot of treatments that don't work.

Does Michael actually want to pursue a lot of treatments that don't work? If so, then he can break open his piggy bank any time he wants and go get them. Even in England, where government controls health care and choice is not a watchword, you can still buy private insurance and, as always, you can go and pay any doctor or witch doctor for anything you want.

To control costs and improve quality in health care, the White House economic team believed that we had to change the way physicians are paid. About 85% of payments to physicians are fees for individual services—which gives doctors incentives to order more tests and interventions. Fee-for-service puts volume above value; it rewards treating sickness rather than promoting health.

"Bundled payments" are widely recognized as a promising new approach to paying doctors. If fee-for-service payment is like ordering a la carte, bundled payment is like a prix fixe menu: It puts all the costs for an episode of care together for one price. [My edit: IOW, no matter how much it costs to heal you, you only pay one fee. Sounds pretty good, no? ] A bundle payment for, say, a hip replacement would include X-rays beforehand, the surgeon's fee, the artificial hip itself and rehabilitation therapy afterward. ["Everything's included" is generally a strong sales pitch for a reason.] Since the doctors are paid one fee for the entire episode of care, regardless of how many tests and scans and drugs they order, they no longer have an incentive to provide unnecessary care for a few extra bucks. When implemented in hospital settings, bundled payments have been shown to encourage providers to improve efficiency and eliminate unnecessary procedures without stinting on care. [Edit: One valid criticism could be that doctors now have an incentive to stint on tests because they'll cut into the doctor's margin, but he discounts that as apparently not what happens.]