The problem is that providers have to hire huge staffs since say they have 1000 patients, of those 1000 patients, they may have to deal with say 25 insurance companies and each patient has different co-pays, deductibles and co-insurance with their policy. Now add to the equation, that 1 company will pay $75 for the service, while another may pay only $60 for the billed amount of $100.

It would be great if every policy paid the same. That every service you get costs the same. You could go into a doctors office or the hospital and they had a listing of costs that you may incur. If you go to a restaurant, you get a menu and know the costs.

If you get 6 tests but only need 3, how do you know, since maybe the doctor is doing this to avoid being sued later on for not doing this. Or you get some processor at the insurance company that tells a doctor who spent years in school that a treatment is not necessary, experimental etc and is not covered.

There are so many "ifs" and no one has the answer.

I like your subject matter, too.

I can write music til the cows come home but I always tell people that I can’t “draw water”. haha.

Thanks for the invite. Rare treat.

it's normal context is referring to the last person leaving the room turning off the lights, often written as a sign next to the doorway, reminding people in buildings such as offices, schools etc that if they are the last person leaving, that they should turn off the lights to save electricity and light-bulbs.

As it is such a well known and used (cliched) phrase, it is being used in this form to imply that physicians are leaving america, and that it is reaching a point where there could be none left (an exaggeration but it gets the point across)

so it is referring to physicians leaving america in increased numbers; analogous with people leaving a room at the end of the day (and the last one has to turn the lights off)