But it’s hardly a market-based system with the third party payers. Consumers aren’t making informed decisions about what they buy, have little ability to comparison shop, and state-level regulations intentionally limit the number of providers in a market. With those attributes, the poor outcome of the “market” system is entirely predictable. We need to go in one direction or the other, but having the worst elements of centrally managed care and the worst elements of a market solution makes for rotten outcomes.