I agree, but I'd note that as you've pointed out, Germany essentially has systems in place to mitigate the default behavior that arises out of the 'few players'

I agree, but I'd note that as you've pointed out, Germany essentially has systems in place to mitigate the default behavior that arises out of the 'few players' problem. Almost all countries do. The US has plenty of healthcare regulations but none that successfully tackle cost. Nowhere near enough work is done to force price transparency, and it's not just that this data is known but not displayed (like a Pharmacy's formulary) but rather that it's often _not known at all_ because there's so much money sloshing around, people just stick their finger into the wind and pencil in their best guess. I think the German model is actually the easiest for the US to achieve and one with the best outcome - a public option under the ACA would be a great start. A *default* public option under the same scheme would be pretty much all we'd need to have the same framework to build from. I think I read that 75% of Germans choose the non-government option and the rest stick with it. That seems like a very healthy balance.