Many doctors will gladly substantially discount their fees in return for up-front payments from people who pay directly for their health care. Hospitals, ambulatory surgical centers, and urgent care clinics do the same. Why shouldn't they? They don't have to pay an army of staff to fill reams of forms and wait weeks to months to collect payment from an insurance company that sometimes is lower than what they get from their direct-pay patients. Yet most of these same providers have much higher "list prices"—the official prices they list publicly—which are used to negotiate compensation contracts with health insurance companies and other third party payers. As Dr. Jeffrey A. Singer points out, health insurance—private or otherwise—does not make health care more affordable. In fact, the third party payment system is the principal force behind health care price inflation.