This is a legitimate problem. For example, up until June the reimbursement rate that we got for our facility was... shitty. Had actually gone down since 1996. But our professional organization put together a package that indicated this, indicated the savings birth centers provide over low-risk births in hospitals, and got a rider attached to a health care bill that upped our reimbursement. Before, we were 1/8th what birth centers in New York State had negotiated. Now we're 1/3rd. Right now, every provider in the state loses money giving expectant mothers rhogam. as a lack of rhogam nearly killed both my father and my grandmother when he was born (it hadn't been invented yet) this is dear to my heart... yet on the raw cost of medicine alone, every provider in the state loses $21 every time they give rhogam. However, medicaid mothers are a tiny fraction of clients for some providers and a major portion for others. Some providers rarely lose that money. Some lose it all the time. But if everyone were to put a bill together to raise the reimbursement rate of rhogam it would cease to be an issue. It's likely that the doctors you know are 100% correct: the reimbursement rates on Medicare are insufficient to cover the cost of care. There's a mechanism, though: 1) Doctors/lobbyists lobby/petition legislators to adjust the fee schedule for procedures and medications 2) Legislators pass legislation apportioning budget resources to cover the new fee schedule 3) The new fee schedule goes into effect immediately. Which looks like a lot of work until you look at the private side: 1) Individual doctors complain to their insurers that the fee schedule is insufficient to cover the costs of care 2) Insurers tell those doctors to pound sand So on the one hand, you've got elected officials arbitrating the reimbursement of care based on the costs (hopefully with the help of professionals on both sides of the issue). On the other hand, you've got insurance companies telling everyone to fuck off. Right now, we're at Aetna and Regence telling everyone to fuck off. With single payer you've put it in the hands of legislators. You can't vote an insurance company out of office. They claim that Medicare disbursements are insufficient to cover the total cost of care (for the provider's clinic as a whole), and that a sudden switch would drive a bunch of practices out of business.