>insurers should stop negotiating individual rates with providers and instead providers should have a set price they charge no matter who pays It's not that si

>insurers should stop negotiating individual rates with providers and instead providers should have a set price they charge no matter who pays It's not that simple, unfortunately. For one thing, Medicare reimburse at rates that are significantly below market prices [0][1]. Medicaid pays even less on average, and Medicaid reimbursement rates vary significantly from state to state [2]. Care providers need to make up for this by charging a higher rate to those who have private insurance or pay cash. The obvious retort to the above is that providers could charge a single, higher rate for everyone except Medicare and Medicaid. But if you prevent providers from offering reduced rates to insurers that include them in their networks, insurers will have an incentive to make their networks narrower, charging higher out-of-network deductibles and copays for a larger proportion of providers. Eliminating provider networks entirely isn't a good option, since they're one of the only mechanisms keeping costs in check to begin with: insurers can remove providers from their networks if they become too expensive (or if the quality of care declines), pushing policyholders to cheaper (and/or higher-quality) providers. To extend your example, say that instead of charging a 30k out-of-network rate and a 7.5k in-network rate for a particular insurer, a provider charges 15k for everyone. Are all insurers required to pay for the procedure at 15k (subject to deductibles and copays paid by policyholders)? If so, what's to stop the provider from charging 30k next year? And if not, what incentive do insurers have to pay for it? [0] https://www.cbo.gov/system/files/115th-congress-2017-2018/workingpaper/53441-workingpaper.pdf https://www.cbo.gov/system/files/115th-congress-2017-2018/wo... [1] https://www.aaos.org/AAOSNow/2017/Oct/Cover/cover01/ https://www.aaos.org/AAOSNow/2017/Oct/Cover/cover01/ [2] https://www.texmed.org/June16Journal/ https://www.texmed.org/June16Journal/