Paul:
I can't answer all the points you raise, but:
I think that almost anywhere you live, there is going to be a segment of society that will want to deal in cash. I have dealt with them, and they are good people. If they exist in a certain number in a small town, I think they would exist in larger numbers in a large city. (I have personal experience with this phenomenon in a small town of 1,329 and a small city of 21,530).
As far as vaccine programs go, they are hugely expensive I know, and I tend to lump that into things that government does best, like building roads and fighting wars.
As to your questions about HMOs and referrals, I think the question you are asking is: how do we do "business as usual" when our practices are no longer doing "business as usual"?
Changing to a cash-only practice would be as drastic as switching your vehicle to run from gasoline to hydrogen: there are obviously lots of advantages, but the problems are new and strange. (Well, not *that* new and strange: cash-only was the standard until WWII and the guys in the above articles have been doing it for years; it would be interesting to pose these questions to them).
A "cash-only" practice would need to be run in a completely different way, and I recognize this might not be practical or comfortable for a lot of people. Still, for anyone that is ready to give the HMO's the heave-ho, this option is an available and viable one, at any time, and (I believe) in almost any population.
Brian
