There is sufficient pathology to bring into doubt the survival of American medicine.  It threatens to collapse down to an ineffective, surly and corrupt bureaucracy, like the Department of Motor Vehicles model in an incompetent State, a bureaucratic nullity that cannot move but only accretes.

Who cares?

If something is to be saved, three questions arise – Is it worthy of being saved?  Does it deserve the quantity of effort to do so?  Is there in fact a practical method by which it can be saved?

I fear that all these answers are ‘no.’  American medicine should not survive if it cannot sustain the town doctor model of an independent practitioner.  That is now impossible.  The regulations on EMR and billing now essentially forbid all private practice excepting direct care, and I fear for the heavy hand of government on the head of DPC.  A government which does not recoil from oppressive behavior in other ways should not mind at all the crushing of individual practices one at a time.

The matter of how much effort it would take to save town doctors and private practice is moot, given that there is no effort simply to stop destroying primary care.

DPC is of course practical; but it is being viewed as the equivalent of the neighborhood heroin dealership by the government and society.