As I mentioned the last time this topic came up, competition is not feasible in healthcare because there are circumstances that demand immediate treatment. You

As I mentioned the last time this topic came up, competition is not feasible in healthcare because there are circumstances that demand immediate treatment. You don't have time to make your choices—you have to take what you get, as well as in situations where there are no other providers within reach, creating a healthcare desert, as it were. The heart attack I had back in 2018 occurred when I was hiking a local mountain. I had to walk out the last couple of tenths of a mile to a road where a ranger could get me. Then I drove myself 40 minutes to the nearest hospital with a cath lab. The local hospital was 20 minutes in the other direction, and they would have seen me, said, "Yep, it's a heart attack," and shipped me to the hospital with a cath lab via expensive ambulance ride, which would have come out of my pocket. From a competitive perspective, the other nearest hospitals with cath labs were 90 minutes and 120 minutes away. This experience with the local hospital, as well as others by myself and family members, is an example of medical care in most of America. However, it is only near a major city, such as Boston, that medical care can be competitive. The heart attack I mentioned was billed to my insurance company at $145,000. If I were on a cash-based medical system as you advocate for, I would have turned to bankruptcy as soon as I got the bill. Some groups would call bankruptcy and income-based payments for crushing medical debt a "moral hazard" and use that as a justification for providing no relief. Fortunately, we don't have to rely on anecdotes. We have a wonderful natural experiment around the world with current medical systems showing how the different systems provide different patient outcomes and give us practical examples of societal and individual costs.