Ireland had a similar problem with false negative cervical cancer screenings . Over 200 women were misdiagnosed and 18 or 19 have died (I think I saw on twitter where at least 1 more died after this article was published): https://www.cbc.ca/news/health/hpv-test-for-cervical-cancer-screening-ireland-1.4735758 In their defense, however, they did send the tests to a low-bidder Texas lab. I agree that there needs to be more localized treatment but my gut instinct is that in any national system there would be an even steeper divide between haves and have nots than we already see in urban v, rural markets. Obamacare has certainly been blamed for smaller rural hospitals closing. I am more conflicted on the direct personal relationship aspect though. Sometimes it is better to have a fresh set of eyes on a problem if the symptoms are similar to a patient's usual complaints and history.