For the most part, Australian general practitioners do not have a clear idea of how the health care system works and how family medicine is practised in the United States of America. We hear that despite the enormous and rising cost (currently $US2.5 trillion per year) many people in the USA still have poor access to health care. We also hear that from the provider's point of view, 'managed care' interferes with clinical freedom and the patient-doctor relationship. Are these accurate impressions? How does family medicine in the USA compare to Australia and are there lessons for us in how they do things?