The biggest obstacle to national health insurance is dislodging the private equity ticks deeply burrowed into the income streams that are supposed to be directed to health care.

I worked for a salary all my professional career though there was a period that my HMO bought into the "productivity" model of compensation championed by for profit entities. That engendered a practice of gamesmanship to "upcode" services to inflate compensation. I was witness to some egregious abuses. It also was responsible for corrupting the use of the revolutionary EPIC medical record system by filling the notes with "cut and paste" meaningless filler to satisfy insurance qualifiers to higher payment. EPIC became more about billing than information.

Refused to play the game and billed almost exclusively "established 3" for 95% of encounters and still made a living.

fd