What's Wrong with Health Care Delivery?

Everyone claims that the U.S. health care system is broken. Which one of the following do you think contributes most to making health care delivery so frustrating and difficult for patients to navigate?
Insurance company precertification and reimbursement policies.
Complexity of Medicare and Medicaid eligibility and filing systems.
Malpractice law and professional fear of lawsuits.
Hospital billing systems.
Lack of coordination of care among the physicians one must see for total care.
Physicians' lack of concern for individual patients.
Physician shortage.
Public's demand for unnecessary services.

Some hospitals and clinics employ "secret shoppers" to report to management on the quality of the clinical encounter they observed while pretending to be patients. Which one of the following best describes your response to this practice?
It's a good idea; poor staff performance and inefficiency cause mistakes and add to the cost of health care.
Used judiciously, it's an effective quality improvement tool.
It's a bad idea; it takes time away from real patients and treats professionals as though they were retail staff.
It's wrong. Medicine is a moral practice and should not employ deception of any kind.