The paradigm shift in medicine is fraught with dichotomies nurse practioner vs primary cre doctors fee for services vs quality outcomes to be paid, business models focused on profit rather than on patent care. Life altering decision taken out of the hands of doctor and left with cost managment types. The american system despite its faults met patients demands. I am troubled by what is going on now because a caste system is taking firm hold where only those who can pay the additional cash will get really quality medical care.
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