text: That is indeed radical. My first reaction is that you can't get there from here, because we have deeply entrenched and powerful interests. Certainly administrators, who control the payroll, overpay themselves and create administration-heavy institutions; this has also happened in education at all levels, but particularly in universities, and that has added tremendously to costs. That situation might be amenable to reform. Maybe a nationalized system in health (and separately, in education) could be initiated as a parallel provider, but given the current political climate I don's see Congress acting on that, any time soon. Perhaps it could emerge from a major catastrophe such as WW II. As it is, many of our physicians seem more dedicated to getting rich than to first, doing no harm.