> Nurse practitioners are, I think, the future of primary care.

Agreed. When I visit my PCP, I normally meet with a NP. I’ve been quite happy with the quality of care received.

> Where we're really spending the money is on long-term and end-of-life care.

With the boomers entering the end-of-life phase of their lives it will be interesting to see if we will be able to change culturally and realize the huge sums of money spent with little benefit to the economy. I’m struggling with this myself currently as my parents are aging (quickly). They don’t have unlimited savings to spend on health care. While I have ample resources, I’m not convinced shelling out $1MM is worth it for them to live with a marginal quality of life for just a couple of years. Just writing that makes me feel like a terrible person but I try to think rationally and without emotions.

Edit to add: I’m genuinely curious about your thoughts on this, @tptacek. I’ve always respected and appreciated your opinion here on HN.

Our unwillingness, on a national level (and perhaps on a civilizational level, though I don't know very much about other countries) to speak plainly about this issue, and address it directly, is one of the most fundamental problems in all of healthcare.