Primary Care Physicians are the gate-keepers to expensive specialty care. Specialists order lots of tests and procedures, prescribe the newest, most expensive medicines and then refer their patients to other specialists. Most patients want to see a specialist, whatever they have. There is no shortage of Specialists. Many PCPs will not take new Medicare, Medicaid or SCHIP patients. The problem? Reimbursement rates are too low. I am a retired doctor. I called up my PCP for an annual checkup in August. His first opening was in November. Everyone is complaining about the high costs of health insurance.Healthcare insurance in America is too expensive for the same reasons that flood insurance is so expensive in New Orleans and hurricane insurance is too expensive in South Florida. Too many people need to use it too often. The only way that health insurance gets less expensive is if/when Americans in very large numbers start taking much better care of themselves. We’ll know that is happening when drug stores start going out of business, and the wait to see your doctor falls to less than 1 week. Don’t hold your breath.