Costs were rising under the old system. Quality might be declining under the new. The main focus is on the Medicare commission. So increased access can weaken the struggle for universality. Quality today is about providers, not about patients.
Systems compete on public versions of quality.
Docs call for return to fee for service for higher quality. More weight for the central role of providers in the current battles. There does not seem to be any significant movement of patients. Patients grumble, they don't roar. HMO's are a pain in the ass.