Who is likely to negotiate the lowest fee with a doctor, hospital or some other health care provider? The federal government? A large employer? An insurance company? Or, a patient spending her own money?

Strange as it may seem, the answer is often the patient.

One of the most persistent myths on the political left is the idea that only government (because of its size and power) can negotiate the lowest fees paid to providers. This myth is frequently repeated by the Physicians for a National Health Program (a longtime advocate of socialized medicine) and by Paul Krugman in his columns in The New York Times.

In fact, private buyers of care often pay less than Medicare pays and sometimes even pay less than Medicaid. Surprisingly, the lowest fees of all are often paid by individuals spending their own money.