The healthcare reform battle rages on.  The conservatives and Republicans have vilified the idea of a single payer system.  The argument is  the consumer will no longer have choices in their healthcare.   I have to laugh.  Many people now don't have choices only the illusion of choice.  Everyone who has insurance is limited by the their insurance contract.  Everyone has in- network and out -of- network providers and hospitals; preferred providers and not so preferred providers.; preferred medications and non preferred brand name medications.  The insurance companies dictate the type of care, the providers and the hospitals.  Yes, it is possible to see out-of-network providers or use a specialty hospital but not always a given.  Most insurers charge at least a 20% coinsurance charge for usage and most are higher.  If you or your doctor forget to request prior approval, then the burden of cost is on you or a long and drawn out grievance process will ensue while the provider sends your bill to collections.