It does not make any difference. The medical practioner is going to pass on
the cost to their customers, one way or the other.

Possibly, but can't effective cost containment be achieved without diverting
so much of the alleged "savings" being diverted away from anything that
actually benefits the patient?  In my actual, real-world experience, it can.
Care to guess how much time a typical family practice doc spends fighting
with insurers and jumping through their pointless hoops instead of seeing
patients, keeping current with medical advances, etc.?  That, alone, induces
a HUGE inefficiency into the "system."

But who gets the money does matter.  Managed care, as practiced by some HMOs
and insurers, is little more than denial of care.  True managed care can
both save costs AND improve the quality and efficiency of care, but is often
not what is done, at least not by private insurers and HMOs.  Most
healthcare and Med Mal attorneys have collected multiple horror stories
about arbitrary and nonsensical abuses by HMOs and private insurers, but the
general public seldom hears them, because employer-paid benefit providers,
which is what almost all HMOs are, are completely exempt from med-mal suits
under ERISA and are further shielded by various other laws.  The amount the
taxpayers and the private sector are willing to pay for healthcare coverage
is elastic, but not unlimited.  I'd be fine with a 20% profit if it could be
shown that it was only a portion of savings realized by improved resource
management and efficiency, but that's not the case.  Its often just a
diversion of money meant for health care into someone else's pocket without
adding any equivalent gain for either me or my healthcare providers.

This is a gross oversimplification of an incredibly complex situation, but
the healthcare industry has been forced to tighten it's belt, so to speak,
while HMOs and insurers have not.  Costs to consumers and taxpayers continue
to spiral into the stratosphere, while the quality, availability and
accessibility of healthcare are either static or even declining.  So where
is that money going?  Part of it goes to the fact that there's simply more
healthcare to be bought ($2000 MRIs v. $200 X-rays, $5 a pill SSRIs v. $1 a
dozen tricyclics, etc.), but part of it is pure profit extracted from what
is the antithesis of a free and open market by rent-seeking HMOs and
insurers.  Are you aware that the Federal government now pays MORE for HMOs
to "manage" its Medicare clients than it costs to just let the existing
bureaucracy handle it?  Do you know what "capitation" is, and how it
influences the decisions your doctor makes about your health care?

Physicians are revenue centers for hospitals, and hospital administrators
have good business reasons to offer, especially, non-financial perks to
physicians.  Occasionally, there are legitimate medical reasons such as
getting on-call physicians into the hospital quickly.  If I bring in your
head-injured kid to the ER, you are gonna want that neurosurgeon in to see
him ASAP.  Medicine is one of the few places were, just occasionally,
seconds can mean the difference between life and death.  But that's rare.
Mainly it's just a customary perk for the folks that bring in the bucks.
Heck, even I take the prime parking space at my office.

But what's up with the hospital you use?  All the hospitals in Pensacola
offer free, no-tipping valet service for every visitor.  They also have
people running those golf cart shuttles through the parking lots to give
both visitors and staff a ride to the door, especially in inclement weather.
Good customer service a thing of the past around Los Banos?

Jeff