This is what the real healthcare debate in America is going to be about.

Obamacare is not going to be repealed and Ted Cruz knows that better than I do. The real debate is not whether or not we are going to have government financing of healthcare. That's now an accomplished fact. The real debate is going to be about how much should we spend on healthcare for the masses.

America is nowhere close to becoming like some Socialist nations that insist that everyone have access to the same kind of care. I, for one, don't think we have to even go that far. The well off will always have a way of getting better care than the not so well off. The real argument in the USA is going to be over: how big should the difference be?

Designing a system where you can't even see a doctor, unless a nurse-gatekeeper allows you to get past her, is one way of differentiating what the masses will get from what the elite will get.

Healthcare organizations are replacing insurance companies. Since they can't charge that premiums that will support the system continuing as it is, they will have to cut costs. Taking away a lot of choice is exactly what they are doing - and have to do - because there is no incentive for individuals to not always go to the best, and most expensive, provider.

People think Obama lied when he said that everyone could keep their doctors. We are seeing the beginning of the reality of people not even having primary care doctors, never mind the doctor of choice. But that's the way things are going to go.

It makes it all the more important for people to get regular checkups. Having the NP as primary provider will work better when the NP knows what is "normal" for a given patient. So, if I find myself having a NP as my main provider, I am going to be in that office with as great a frequency as I can arrange. Follow-up visits will become more important, as NPs will need those to catch the greater number of mistakes they will make compared to PCP MDs.