requiring a huge parasitic bureaucratic diaspora at providers' offices to handle the local paperwork, buffering providers and secondary providers from market forces and encouraging fee increases, changing the medical culture from service-providers to corporations. The above is before insurance company profits, and applies to public programs as well as private..
-- It's a lot easier to justify huge fee increases when you're taking money from a deep-pocketed third-party payer than from your neighbors. Of course, it comes back to the neighbors eventually, as premiums or taxes. Face to face payment involves human contact. Third-party cost-control requires arbitrary, inflexible policies and adversarial relations with patients and providers.