[Restorer]

The major difference in medical offices in the last half-century is the camp of forms-processers behind the receptionist.

He blows right by this as unimportant, but over half the time of medical office staff is spent processing forms or talking to HMOs on the phone. Some offices now give a 50%+ discount to those who pay cash.

This undoubtedly increases medicals costs by 1/3 (?).

[FairWitness]

The major difference in medical offices in the last half-century is the camp of forms-processers behind the receptionist.

He blows right by this as unimportant, - -

I agree that's important, but I suspect the author assumed it was not something the doctor could directly affect, whereas "mass production" (if accepted by patients) is within the doctor's control.