TY - JOUR T1 - 33 years of changes, and lack of changes, in US general practice JF - British Journal of General Practice JO - Br J Gen Pract SP - 372 LP - 372 DO - 10.3399/bjgp12X652436 VL - 62 IS - 600 AU - Alan Searle Y1 - 2012/07/01 UR - http://bjgp.org/content/62/600/372.abstract N2 - Six years ago I was one of a group of doctors who visited Vietnam. We gave presentations to Vietnamese colleagues on our favourite topics. I made the mistake of asking what they would be interested in and ended up lecturing on the American Medical Insurance System. This is hard enough to explain to an American. Whatever part of my talk was not lost in translation evaporated as the Vietnamese GPs, who earned between $100–200 per month, tried to get their heads around the details I presented.‘You mean that it costs $12 000 annual premium for a family of four, and you still have a co-pay of $25 for each visit?’Sometimes I can't get my head around it. And those were figures from 6 years ago. A more recent estimate is that a family of four could expect to pay $20 000 on health care annually.I moved to the US 33 years ago. I had just turned 31, was married, and still childless. It was a big adventure and an adventurous alternative to settling down in UK general practice. Besides, I was only going to try it for 5 years.Somewhere along the way I forgot to go back, and somewhere in those 33 years the … ER -