I think this is it. Imho, you essentially have two populations of patients: those with good enough jobs to have good enough insurance that their fairly price i

I think this is it. Imho, you essentially have two populations of patients: those with good enough jobs to have good enough insurance that their fairly price insensitive in most cases, and those who are under-employed and/or under-insured who know going in they can't afford to pay for service regardless. Neither of these groups are particularly invested in effecting change to the status quo. On the flip side, though, there is a large population in the middle where price matters a lot ... but imho these voters are overwhelmed in their PR efforts by the big spenders at the top, and the under-insured are effectively disenfranchised anyway, so their voice doesn't matter much (Medicare/Medicaid & VA services are the exception here).