"The fee-for-service reimbursement bureaucracy multiplies the box-checking and skewing of sensible judgment (doctors spend 30% of their time on paperwork). Regulatory overload in health care causes various forms of failure -- unnecessary cost, grotesque inefficiency, corrosion of professional judgment, and a palpable degradation of professional spirit. Then pile on top of this the ability of any sick person to bring a lawsuit against a doctor in almost any amount, without any reliable decision maker, and -- voila -- you have the world's most expensive healthcare system, by almost a factor of two, and perhaps the most dispirited medical professionals in the developed world."

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