Perhaps I'm old fashioned in believeing that hospitals should be public services, rather than profit-making private companies? MM, you talk about bureaucracy, but the kind of system you describe would surely be vastly more paperwork-heavy. Have you ever needed medical attention in America? I used to think the privatisation was a good thing, and that competition would inevitably lead to better value and service, but there are just too many counter-examples for me th believe that any more.