Forbes January 25, 2022
Robert Pearl, M.D.

Between this century and the last, practically everything about American healthcare has changed.

Patient problems went from mostly acute and unexpected (think: broken bones and appendicitis) to predominantly chronic (heart disease, arthritis, diabetes and so on). As medical problems got more complicated, treatments became more sophisticated and wildly expensive. With the rise of for-profit insurance and “managed care” in the late 20th-century, doctors were driven to see more patients per day—spending up to half those visits on the computer for insurance and billing purposes. As a result, the relationship between patients and doctors changed and not for the better.

Amid these ups and downs, one aspect of healthcare has remained the same: the way we pay doctors. As it was...

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