The biggest issue in US healthcare is the third party payer. In American healthcare (as it is in much of the world), the patient is not the customer. Instead, medical care is structured in a way that best serves the payer: the insurance company and the government. Everything in a doctor's office, from the paperwork, to the amount of time providers spend on documentation, and the various medical-care related restrictions, are a function of healthcare rationing. The patient's experience (and to a large degree the doctor's) is not improved by this practice; however, it is the sort of litigious environment quite suitable for insurance. To be clear, I do not blame either the insurance company or the healthcare providers for this predicament. They are operating their business in a way that makes it sustainable. The insurance companies have to insure the healthcare provided is truly necessary to stay in business, and the provided has to be paid. As unpopular as it sounds, healthcare should be an out of pocket expense. We should budget for healthcare like we do for vehicle maintenance or house repairs. While insurance occasionally contributes in the case of unexpected catastrophe, it is the customer who pays the most costs. That way, healthcare will adapt to serve the patient's needs. If they really want an MRI, they can get one; however, if they don't need one, they are less likely to pressure their physician to give them something they don't need. It would reduce costs and improve performance. Patients would consider price and prices would fall. We can provide for exceptional cases in exceptional circumstances of course, but, because of market forces, prices would be less lower and the services would be better.