Please allow me to counter, from the perspective of someone who owned a medical practice for much of my adult life:
- The ACA limits the amount of money, as a percent of revenue, that insurance companies collect as profit. If they wish to increase profit, their primary option is to collect higher premiums and pay more benefits.
- (No experience with keeping someone alive overnight. I'm sure it's happened and couldn't disprove it in any case.)
- Of course they have optimized billing. The current fiasco has byzantine rules for payment. For instance, you know how your dermatologist offers you smoking cessation and weight loss classes? That's because if they offer it to you, insurance rules allow them to bill the encounter as an enhanced care visit which pays more. This isn't an exaggeration. The insurance rules say "we'll pay you an extra 30% if you ask about their smoking and weight". The doctor can earn more simply by following those rules. Again, of course providers do this! If my boss gave me a 20% raise for asking him each morning if he'd like me to make him a sandwich, even knowing he hates breakfast sandwiches, you bet I'm doing it.
- That's complicated. If a hospital violates the insurer's rules, they don't get paid for seeing the patient. Yes, the situation you described is horrid, but no provider can afford to write off every patient. It's the insurers who said they wouldn't pay until the patient is seriously sick.
- Surveys have shown that as much as 60% of small practices' management overhead involves staffing people to deal with insurance companies, process claims, optimize billing (see above), negotiate pre-approvals, and so on. They have higher overheads because the insurers require it, not because they want to.
- Well, according to the insurers trying to weasel out of paying for it. For example, a patient came to my wife with an obvious soft tissue injury. She ordered an MRI to diagnose it. The insurer refused the approval until my wife took an X-ray first because it's cheaper. X-rays also don't show soft tissue injuries. (Don't correct me; I know the exceptions here and they're not relevant to this.) So it was the insurer who demanded my wife perform a wholly useless test before they'd pay for the effective one.
- I'm not willing to lower the quality of physicians. Other studies have shown that the lack of upcoming doctors is due to fewer people willing to put up with the insane stress levels for mediocre pay. The stereotype of a doctor heading out at noon for an afternoon of golf are largely over for nearly all specialties. Frankly, there are many jobs that pay better with less stress and less personal responsibility.
- That's laughably wrong. No one gets a new knee for the fun of it. It's a major surgery with long and challenging recovery that people get because they're otherwise unable to function normally.
- There is no way to handle this efficiently. It's an utter morass.