On 4 October, more than 75,000 employees of the large healthcare chain Kaiser Permanente began a three-day strike. The strike was the largest in the history of the US health care industry and highlighted the staff shortages plaguing the country's hospitals and clinics. In the same week, ten drug manufacturers announced they would negotiate drug prices with Medicare, the public health care system for the elderly, following legislation that almost forced them to do so. It will be the first time the companies will negotiate prices with the government.

These events are symptoms of a deeper malaise in America's dysfunctional health care system. The country spends approximately $4.3 trillion a year keeping its citizens well. This is equivalent to 17 % of gross domestic product, twice the average in other rich economies. Yet American adults are living shorter lives and American children are dying at a higher rate than in similarly wealthy countries. Pharmaceutical companies and hospitals draw most of the public's ire because of exorbitant costs. Much less attention is paid to the small number of middlemen who extract much larger rents from the complexity of the system.

Economist/USA