I am a private practice orthopedic surgeon.  I can tell you one of the MAJOR problems with our health care system is the lack of competition between hospitals and the true private sector. Hospital care is atrocious and care is much better provided by the small private practice Doc.  It's better care at a cheaper price.  Hospital expenses are KILLING our healthcare system.  They're driving up costs which get passed on to the consumer.  Hospitals are an outdated model of care delivery.  90% of medicine is done on an outpatient basis and as such can be done cheaper at a free-standing surgery center, clinic, etc.  Hospitals claim not-for-profit status to hide money and shield themselves from taxes.  They essentially use tax dollars (Medicare & Medicaid) but then contribute nothing to refill that pool of $ (pay no taxes).  The American Hospital Assoc lobbies tons of money to prevent private physician-owned facilities from being opened.  Hospitals are literally ruining healthcare.