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What you're proposing is a strictly two tiered system. Economics would drive the providers to provide the services that compensate them the best. As soon as you have the relief valve of "Well if people want to pay for xxxxx then they can, on their own", that is EXACTLY where the services gravitate. And it's not always a bad choice. The problem with directed care is they have to treat you with the person they have. When I worked for a PPO we had providers under indictment for sexually molesting patients and we HAD to continue to refer patients to them because of the specialities they covered. Somehow when it's my wife's life on the line I'll figure out how to pay the private practice specialist out of network in lieu of a drug addict incompetent loser my PPO foists on me.
