Not only is third party payer a problem but government handing out taxpayer money to all kinds of groups is the main problem in my view. When we are receiving money from the Feds we are beholden to them and remain silent when our representatives pass legislation that is not constitutional. After all, we can't lose our health care, social security, earned income credits, etc so we sell our souls for Fed money. Why should Medicaid be block granted back to the states? Why do we allow the Feds to tax us and turn around and send our money to whomever they please? We need to have an honest discussion about how much government we want while considering if we keep going down the current path we will soon fulfill Khrushchev's prophesy!