dpb wrote:

The "competition" between physicians for expert medical care is a
fallacy -- in general the consumer has insufficient expertise to judge
quality or to know how to select alternate care options for the
highest efficacy. When forced to make difficult decisions on perhaps
life-or-death issues, in the end its not likely that the overriding
concern will be the cost. Easy enough to hypothesize that's what the
so-called rational consumer SHOULD do, but just as the markets are as
much or more emotion-driven, health care choices are as well.

I can't answer all your concerns, but quality can be judged by those
competent to make the call; in this case, your family physician. If he
refers you to a specialist that's not quite appropriate, some of the blame
will trickle down to him and he'll (usually) adjust his referrals
accordingly.

My internist has referred me to three different specialists (opthamologist,
plastic surgeon, and orthopedic physician). Upon my return to him, the
internist inquired as to whether I was treated properly by the referral.

The health-care delivery system in the U.S. is not perfect by any measure.
It is, however, like democracy, better than any other system available.
While there are problems, the vast majority of Americans are satisfied with
their options.

What worries me is that the very real possibility of ****ing-up something
that works properly for 250 million citizens in the hope that a few
under-served people will be helped.

Another issue - and I don't recall whether you mentioned it - is physician
liability. My state, Texas, instituted a severe tort reform measure four
years ago. Among other things, it capped non-economic losses (pain &
suffering, punitive damages) at $250,000. We've stopped hemorrhaging
physicians and, in fact, had a tremendous increase in doctors moving here
from less-enlightened places.