Medical diagnostic in US is highly investigative and less intuitive. The culture in the society also adds to rising cost – people don't want to discuss their medical cases with friends and relatives and hence rely only on hospitals as providers. In contrast to other countries, where the provider role is shared by dispensaries, hospitals, chemists, family, collegaues, neighbours. There is no money exchanged when I ask my chemist – what medicine should I take? or when patients treat each other! The choices for treatment makes services competitive.

The only way out is less insurance, and less governance. Only Ingenuity is cost-effective. Obama may just transfer the problem from premiums to tax payments. I hope he does not.