> I don’t know what you read in the NYT but this is well-known in healthcare.

Time Magazine, not the New York Times. I don't know what you think but it's commonly known that the chargemaster is indeed bloated to cover things like indigent, uninsured patients. Here's the thing, people without money use the emergency department for primary care because they cannot be turned away. That's expensive. Getting those folks covered and away from the ER absolutely reduces costs.

https://time.com/198/bitter-pill-why-medical-bills-are-killi...

> By law, Medicare’s payments approximate a hospital’s cost of providing a service, including overhead, equipment and salaries.

So I'm not sure what you're talking about. Obviously Medicare doesn't exist to guarantee a profit. Whatever fee schedule is negotiated with private insurance companies does not actually reflect the cost of providing a service – the negotiated rates include things like profit and taking care of patients who can't pay.

> I’m not exactly sure what happened at UCSF with your ultrasound. Not familiar with SF really. But you can look up mean wait time for most elective procedures in the USA vs. Canada or USA vs. the UK. Or access to new therapies.

Dunno what to tell you. My experience was back in the mid-00s, and I doubt anything's improved since then. It didn't then (and doesn't now) take much effort to find people struggling just to find a doctor that takes insurance. I couldn't tell you why UCSF was so short of ultrasound techs, but yeah I potentially could've found an outside (but still in-network) provider on shorter notice. But then I would've been on the hook to deal with insurance billing hell. Even (especially) with UCSF I was getting screwed by their chaotic billing. Labs that were part of an office visit were officially covered by my insurance but as they were billed separately they were not considered part of the office visit (and therefor not covered).

https://www.beckershospitalreview.com/hospital-physician-rel...

Average wait time for an appointment as a new patient 24 days, worst metro area was Boston at 52 days. 45 days to see a cardiologist in Boston, 51 days to see an ob-gyn in Philly. We're already rationing care (by financial means instead of need), and that's largely due to insurance.

While there was a multi-month waitlist for a GP that took new patients and insurance, the fee-for-service practice I used could typically schedule even new patients same day or same week at least. Hell, their rates weren't even obscene as their practice was almost entirely MDs and a single receptionist. They didn't have to fund an army of people to battle insurance bureaucracy. Over the years my GP went out on her own practice for a bit, and then as her circumstances changed she went back to a practice she'd been with years before. From a patient POV the biggest problem she had was finding competent non-degreed office staff.

I can't say for certain that single payer (or even just a dominant federal government run system) would crate a "renaissance of PCPs", but anything that reduces the administrative burden will reduce the cost of running a medical practice and by extension will reduce the urge to focus on specialties.