Having launched web applications in both markets I can say with a high degree of confidence that both systems are far from perfect. However, I think the US system suffers the most because it is "stuck in the middle". It struggles to benefit from innovation because antiquated payment models often delay (if not outright discourage) it. E.g., use of e-mail is a NEW phenomemon for many US docs. So we don't get the benefit of truly free markets working quickly to highlight/exploit inefficiencies. On the flip side, we get the bloat but not the benefits of a single payer system- even though most care is paid for by the government. I think a single-payer system would be a local maximum but a truly free market would be the most optimal.