I worked for an HMO for about six years. Streamlining paperwork is a difficult issue. For instance, my HMO assigned patient numbers. There were carve-outs for cardio, vision, pharmacy, etc. that we bundled with our product to sell (this is very common practice). Now, get sick enough that you have to use two or more of these carve-out products. Guess what? Each carve-out is owned and operated by a separate company, with separate billing systems, with separate payment rules, with (perhaps most of all) seperate member (read patient) id numbers. Some in the industry pushed for "universal member numbers". That would certainly help in streamlining paperwork, but raises well justified (imo) concerns about confidentiality of medical information.

If you want the world to know the information, put it on a system of networked computing devices. If you're going to seriously streamline paperwork, computer networks will be used. So, be careful what you ask for.

The real problem with HMO's is that they only went after one glutton in the US. On the coasts, HMO's finally got down to where they gleefully spoke of reducing clinician salaries to approx. 120% of Medi-Care payments for the same services. That's bad, but better than they faired with drug companies and hospitals. In the Midwest, it was more like "down to 150-170% of Medi-Care".

The industry average overhead for claims processing when I left the industry in 2000 was 16%. That's high enough, but I don't know what the costs were of traditional indemnity plan processing (aside: ours ran between 10.5 and 11 per cent).

The real culprits of high medical costs are (in no particular order):

1. Americans wanting to live forever and being willing to spend their great-great-great-great-grandchildren's money to stay alive on a vent for "just one more day".
2. Obscene profiteering by drug companies.
3. Hospitals making an obscene profit (including not-for-profits).
4. Clinician salaries.

Each contributes, reasonable minds may differ on order.