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Originally Posted by deltav
It does though. Any organization and/or endeavor becomes more cumbersome, less nimble and able to adapt, and less efficient the larger it gets. Not that lobbyists & insurance/pharm industries aren't the primary culprits, and it's true that Germany manages alright with about 1/4 the population of USA. But that aside IMO it's just too big and too polarized politically & socially to resolve this shit anytime soon.
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I think the polarization has more to do with it than the size.
There are states that are refusing to expand their medicaid enrollment even though the feds will pay for it because they are against Obamacare. In many cases it doesn't matter what one party does, the other will oppose it simply for political reasons. Add in the ever expanding ability of big businesses and wealthy individuals to give unlimited amounts of money to campaigns and companies can effectively buy opposition to something the don't like.
A major overhaul of our system to include something that actually reduced costs would take a herculean effort. I don't think anything like that can happen unless one part or the other clearly runs the countries (not just with a majority, but by making the other party irrelevant) or the system finally reaches critical mass and the people, no matter what their political ideals, demand a real change.