@dfeldman Private sector purchasers definitely face that same determination, and as individuals we experience the same rapaciousness when, eg, we interact with private-equity-owned medicine or housing providers for example. Their "efficiency" is in large part a willingness to squeeze customers in ways that local, customer-interacting business people still balk at, for ethical and customary reasons. As individuals, we face a cost disease from minimal market power and motivated counterparties. 4/