The Insanity of Third Party Payment for Medical Goods and Services

I recently got billed from a local lab for a PSA test for $90+. I had the test done in August since I was getting blood drawn for other blood work. Medicare disapproved it because it was a month early (usually get it around my birthday in September). My wife said I should have known better. So I forgot to say "Mother, may I" and got my hand slapped.
The Medicare reimbursment for this test (i,e, what the lab would ha...ve gotten if I had done it in September) is ~ $25. Having run a little office lab for a few years when we had a 4 doctor group, I can assure everyone that one can make a profit with Medicare reimbursement, even with a little office lab running very part time.
Let me say that I don't consider the lab to be the culprit here. Like every other medical provider their fees are set by insurance reimbursement rather than their cost of doing business and their competition. (This particular lab provides a substantial screening lab package for uninsured patients for a very reasonable price and we send our free clinic patients there to take advantage of it.)
The fee is set to capture the highest insurer reimbursement. The overwhelming majority of their customers are insured and are concerned only about their co-pays and deductables, so the only ones who are discomfited are the uninsured or the bumblers like myself.
There's tremendous more to say about the insanity of our third party payment system in medical care but I'd like to keep it short. Let me just make the point that, if the standard way to pay for this test was directly out of pocket, the price to the consumer would be much, much lower than the Medicare reimbursement and in fact most likely much lower than many present-day insurance co-pays. Furthermore we could have the test done at our convenience without having to say "Mother, may I."
I'd love to have a discussion about this general subject. The public needs to be informed about why medical costs are high and increasing and at the same time why responsiveness to public demand is so limited.

Direct Patient Care: The New-Old Style of Medical Practice

I saw an interesting new website, jointhewedge.com. It's trying to develop a listing of doctors accross the country who are joining the growing movement of direct patient care - essentially a cash based practice. Although still small in number increasingly doctors are considering this difficult step as the only way of getting out from under the oppressive thumb of the so called health care planners who are destroying medical practice and patient care in the face of all common sense.

This is medical care on the old model which existed when I started, infinitely better than what we've got today. I'm not talking about all the new technological development which has been amazing, but the essence of the doctor-patient relationship.

These days more patients with high deductables and health savings accounts are looking for doctors whose fees are more affordable and comprehensable, and at the same time who will provide more time and personal attention to their concerns. This is the point of the website.

I hope I get some pushback on this comment since it's an important subject which is likely to be increasingly common as the government introduces even more new drastic regulations and changes to medical practice.