My annual physical used to begin with a visit to my doctor’s office, where lab work would be completed by his nurse. About a week later, I would report to the same office where the same nurse would take an EKG, the “vitals”, and lead me to my doctor’s office. He would chat with me about my general health, do a thorough exam, and then review all the results. It was one stop shopping, involving two health professionals. Recently, I completed my annual physical under my new HMO, managed care plan. It started with a nurse and an internist, both of whom I liked. The doctor wrote four orders, one for lab work, one for a vaccination, and two for referrals to other physicians. The vaccination involved going to a pharmacy, picking up the medicine, and taking it to another location to have it injected. In total, the same care I used to receive from two health professionals now involved nine. In round numbers, the US will spend about 20% of the GDP annually on health care. Obama must be doing something right; now 9 people have jobs, where only 2 were required before.

 http://youtu.be/sark4O1iRXQ