Every health deform care wonk will tell you that unless we remake the US into one giant network of Mayo Clinics, we'll never get health care spending down to a reasonable level.

Meanwhile, although the original Mayo Clinic in Rochester MN and the satellite Mayo in Jacksonville FL haven't said anything, at least one Mayo in Arizona is opting out.

Or, to ask the question in a more sophisticated way, who are the "strategic defaulters"? The LA Times asked that question:

Who is more likely to walk away from a house and a mortgage -- a person with super-prime credit scores or someone with lower scores?

The answer may surprise you -- especially if this was your narrative:

[OBAMA] In the past, if you found yourself in a situation like this, you could have sold your home and bought a smaller one with more affordable payments. Or you could have refinanced your home at a lower rate. But today, home values have fallen so sharply that even if you made a large down payment, the current value of your mortgage may still be higher than the current value of your house. So no bank will return your calls, and no sale will return your investment.

"You can't afford to leave and you can't afford to stay. So you cut back on luxuries. Then you cut back on necessities. You spend down your savings to keep up with your payments. Then you open the retirement fund. Then you use the credit cards. And when you've gone through everything you have, and done everything you can, you have no choice but to default on your loan. And so your home joins the nearly six million others in foreclosure or at risk of foreclosure across the country, including roughly 150,000 right here in Arizona.

Except that's not what is happening. At all.

Long, and very wonkish, answer here. It's a nice primer, quite readable, and well worth your time.

The longer answer is more complex than just yes-or-no, because modern health care, even in the best of worlds, is complex. While I think that Medicare's labyrinthine payment system has just added to this problem, that's a subject for another day.

Meanwhile, the last two sections of the post make a nice summary:

And Another Thing...

One other consideration deserves attention.
Hospitals base their cost calculations on spreading the costs of various operating expenses evenly over all patients. However, there is at least one important area where Medicare patients actually cost hospitals considerably less than private insurance patients: the cost of billing for services.

Study after study shows that it costs hospitals 50% to 75% less to bill Medicare than to bill private insurers. In fact, for the mythical “average” hospital, the loss from Medicare of 3% to 7% may actually be cancelled out by the lower costs of billing. This is an area of hospital management where costs are actually being shifted from private insurance to Medicare, rather than the classic opposite.