In a Utopian society, doctors definitely set their fees according to what their patients could pay. But in the real world, where we all live, this can only hoped to be true. This principle was mentioned by Starr in this chapter, and once before in book one, as if it was a given. I highly doubt that. This would be better stated as: doctors set their fees in order to get from their patients the maximum they could pay. And when the state is paying, if regulations are not tight, then it becomes,”the most the state is willing to pay.”
This cost issue, recognized by a Union in Butler when they questioned that bargaining for more medical benefits seemed to benefit the medical professionals more than the union’s members, as Starr points out, is central to regulating soaring costs of healthcare and it follows that price negotiation with providers could be at the heart of any meaningful health care reform meant to provide more access to people who need it.
The key to realizing why there was a “triumph of accommodation” in my opinion was that physicians benefited greatly from the insurance system as it stood; they were always paid the rates they set without negotiations, they were guaranteed payment for their services, and they enjoyed their professional liberty to the fullest. Physicians were ‘masters’ of the medical profession and they did not see any faults with the system. It was only natural that they resist any changes lest they undermine their authority and money-making potential.
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