First, thank you for your thoughtful and detailed reply. > Note that I'm saying nothing about whether or not patients can choose physicians intelligently I do

First, thank you for your thoughtful and detailed reply. > Note that I'm saying nothing about whether or not patients can choose physicians intelligently I don't think I communicated very well... I was referring almost exclusively to this. Even this might be too specific... picking a good "provider" (e.g., a "brand", one level above a physician) might be the best an individual could do (since evaluating an individual physician might be too difficult). It's all academic, really. Since the government pays for medical services directly (via Medicare and Medicaid) it's a given that the government has to pay for a huge organization to vet the individuals and groups its reimbursing. This means there's not as much of a "hole" for the private market to fill...