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A cartoon in the May 5 edition of "The New Yorker" shows one doctor whispering to a colleague as they cross paths in a hospital corridor. "Psst....Quit taking insurance. Pass it on." With more and more medical providers refusing to deal with bean counters at HMOs, PPOs or standard health insurers, what are we going to do if the entire profession makes this standard operation procedure?

Of course, this wouldn't mean the end of health insurance, but it would be a radical wakeup call for tens of millions of people, who would have to pay doctors and other medical care providers out of their own pockets, and then fight with their insurers for reimbursement.

With "standard" fees so arbitrary these days, and often so far below what doctors want to charge, the financial load dumped onto claimants could bankrupt many.

On the other hand, might it not also sensitize more people to the true cost of health care, and create better shoppers and more informed consumers? That's what the private market crowd would argue.

Ideally, that might be true, but in reality, average people would have a tough time "shopping" for care, let alone negotiating fees with doctors--especially during a health crisis, when there is simply no time to spare.

This is no worst-case scenario we're talking about here. A growing number of doctors are fed up with having to hire an army of clerks just to file the paperwork and harass insurers for payments. Many are just throwing up their hands and telling patients it's their problem! Here is my bill, pay it in full, and YOU go argue reimbursement with your carrier. Good luck to you!

If anything would cinch political support for universal health insurance, this, I think, would be it.

Is there a better alternative? You tell me.

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