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.