customers: 5 with private insurance and 5 with Medicare, and private insurance pays $15,000 to the hospital for a given procedure while Medicare pays the hospital $6,000 for the same procedure. Now the hospital has performed 10 procedures and received $105,000 for them. If the same 10 people presented to the hospital - but private insurance is illegal and all 10 patients have Medicare - the hospital will be forced to provide 10 procedures for $60,000 unless Medicare increases reimbursement rates (and if they do, then *poof* there go the cost savings).

Now: you tell me what type of organization could see reimbursement for services decline like that and have zero effect on the quality of the service?