There are some young approaches to solving this problem. One I just discovered today is Qliance, a low-cost version of boutique care, dubbed "direct primary ca

There are some young approaches to solving this problem. One I just discovered today is Qliance, a low-cost version of boutique care, dubbed "direct primary care." No insurance needed or accepted (thus no coding or paperwork), ~$50 a month, same or next-day appointments, 24hr access to care, they take their own xrays for free and dispense their own medicine at cost, &c. Aside from making workloads managable (800 patients instead of 2-3000), the really interesting part is how this does away with the perverse incentives of insurance payments (which reward procedures rather than health, and which turns primary care into 10 minute referral-fests, rather than actual care), as well as sets up other good incentives, which reward the doctors for keeping the patient healthy (healthy patients don't need to spend a bunch of time in your office) and so on. His talk is really interesting: http://health.scribemedia.org/2008/01/21/garrison-bliss-pioneer-medical-practice/ http://health.scribemedia.org/2008/01/21/garrison-bliss-pion...