that are inadequate to avoid financial hardship. Many will move into the Medicaid program which has more expansive coverage, but which reimburses providers at such a low rate that far too many will not be willing to accept patients under this program. With Medicaid chasing away providers, it too has become another form of underinsurance. Thus the touted increase in insurance enrollment under PPACA will be more than offset by the explosion in underinsurance - affecting the majority of Americans. What about report cards on physicians? Won't they reduce costs and improve quality? The best study of the impact of report cards on providers (a study of heart surgeons in New York) found they actually increased costs, worsened care, and inevitably gave physicians incentives to avoid the sickest patients.  Several papers have documented the destructive effect of the NY Dept of Health's heart surgery report cards. The best is by Dranove et al, available here . Here's a quote from the Dranove paper: "[O]ur results show that report cards [on heart surgeons] led to increased expenditures for both healthy and sick patients, marginal health benefits for healthy patients, and major adverse health consequences for sicker patients. Thus, we conclude that report cards reduced our measure of welfare over the time period of our study" (p. 577). "[M]andatory reporting mechanisms inevitably give providers the incentive to decline to treat more difficult and complicated patients" (p. 581). Why are health care costs rising and how can single payer "bend the cost curve"?