As Peter Thiel pointed out in Zero to One, in an idealized free market, profit is impossible. Pure competition drives profit margins to zero. This can be easily observed in highly competitive industries, like groceries or gas stations. They operate on razor-thin margins. The only way to make big money in competitive markets is huge scale, which explains consolidation and the drive of money to the top. All substantial profitability comes from friction or monopoly (including localized monopoly, like not having a full range of choices for your employee-based insurance).

But I digress.

At any rate, the Japanese system clearly works, while the American system is clearly broken. One is selling the same product for half the price of the other. Assuming I'm right about the key differentiator being the Japanese price controls (I could be wrong), then it really makes me wonder why we aren't trying that. Seems like a great way to get costs under control (even shrinking), while preserving much of the complex market and avoiding radical change to almost 20% of the economy.

I think "critical utility services" touches on the importance, but doesn't go far enough. I believe a health care system that denies care purely out of poverty is immoral. A health care system that is the primary cause of bankruptcy for the middle class is immoral. A system that traps employees in jobs they hate, for fear of losing (or even changing) their insurance is both immoral and un-American - what's more American than quitting your job to get a better one, or start your own business? So our system is not just an economic failure, it's a moral failure. It's a stain on our honor and an insult to our values.

In conclusion, I do not give a fuck about "free market" here. I am not putting economic ideology ahead of moral imperatives, and I'm not choosing ideology over observable facts. If I wanted to choose ideology over economic reality, I'd be a communist.