The German model would be hard to implement here. If consortia of insurers and providers negotiated rates, it would smack of an antitrust violation. The French and Japanese model, where government sets fees, makes more sense for the U.S., and Medicare is the obvious body for carrying this out. Rates would apply to all insurers: Medicare, state Medicaid programs, private payers, and the uninsured as well. The system would apply to physician, inpatient and outpatient hospital care, and pharmaceuticals.