Maybe they're referring to the way the system is set up. You're probably not going to shop around for the lowest cost heart surgeon unless you have no insurance. Will they even say how much they charge? Couple that with emergencies. I think the only hope for America is a movement to stop a lot of this stuff before they become issues. Early diagnosis of cancer, national movement to unfat America (whatever that mean), people feeling more responsible for their own health inasmuch as they can.