The "third-party-decider economy" is best exemplified by the health care industry, in which insurers negotiate with providers rather than patients.
Ms. Concepcion has organized every bill and medical statement into bulging folders, and said she had spent hours on the phone trying to negotiate with providers.
An all payer system has the potential to reduce health care costs in several ways, including the discipline of a fee schedule on providers, the schedule to be negotiated with providers on a regional basis, and a reduction in the enormous complexity and high administrative costs of the current system.
"The public option must go out and negotiate with providers, just like private health insurance companies do," Ross said.
Medicare currently has the power, thanks to its size, to negotiate with providers for lower rates, which means that rates would automatically go up for people currently on Medicare if Ryan's plan went into effect.
Now we've leveled the playing field, if there is a government option they'll have to go out again and negotiate with providers just like private insurance companies do.
The idea behind managed competition is that insurers negotiate with providers on behalf of consumers.
Communities or individual users communicate their needs and complaints with regard to the services offered to their elected councillors, who in turn negotiate with providers or the Ministry of Health to improve performance.
For small care-groups, commissioners often ally with other nearby commissioners to achieve managerial economies of scale and greater bargaining power when negotiating with specialised providers but, especially in larger cities, several NHS commissioners at times negotiate separately with one provider.
