It's also a really weird two-tier system, private practice and everything else. When I worked in the US I just went to the local community health place like I would have done back home and... it was pretty shocking. It was literally like clinics I've been to in Africa, junk piled up everywhere, grubby and run-down, a few hugely overworked and most likely criminally underpaid staff trying to cope. And this was in (well-off) Westchester County in New York, not some holler somewhere.