Health care in the United States is struggling to redefine itself. We have been spending twice what other countries spend on health care, yet our citizens are less healthy. We now have legislation to create more or less universal insurance coverage, and we are about to embark on a technology-driven quest for quality and uniformity. At the same time, Americans are increasingly turning to alternative health care practitioners, mostly at their own expense, because the health care system is not meeting their needs.
In the three decades since I entered this profession the typical role of physicians has changed dramatically. In the 1980’s most doctors were self-employed and received payment directly from their patients. Now most doctors are employees who receive their salaries from organizations that collect payment from insurance companies on behalf of the patients.