Andrew, I just came back from a year's sabbatical at Stanford, and of course I had health insurance while there, being one of those lucky well paid middle class types. I had some problems with my shoulder, so used my benefits. Both at the hospital and my "primary physician"s offices, everything was spacious, clean and comfortable; I got seen and treated quickly; I owned my own X-rays; every time I was seen I got a general check over. At first this seemed great, but soon I thought "hang on, I'm paying for this - or rather Stanford is, mostly. How about a less luxurious but still easily acceptable version that costs half as much ?" Not available. Meanwhile, lots of less well off folk of course have no coverage, or a standard of care that is much less than acceptable. This is a very strange mixture.