As a doctor in practice for 30 years who ran my own office, ran my own small business separately from this as well,
have had experience working for a hospital group as well, have worked with Medicare, Medicaid, private insurance, and private pay extensively.......this is exactly my understanding as well.
The one thing I would argue is the part about drug company R&D. Pharma uses that threat of not enough money for R&D every time there is even a hint of a cut....all the while they have raped us more than any other group in the medical field. Perhaps if the toned down their search for the holy grail pill that gives a 10 hour erection that leaves the penis 2 inches longer afterwards, we might find a more favorable pricing structure for the other drugs.