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We have a very similar problem in health care access as we do in media --television and radio-- access. Private fiefdoms have been set up on top of the public in order to enrich the feudal lords at the expense of the common people. Why? Because this arrangement provides the aristocrats with enough financial and political clout to control who gets to run for important elected offices, like Congress, Senate, or President of the United States. Like O'Brien said in 1984: There's no ultimate reason for wanting power. It is the end in itself. After a high, single-digit number of gin and tonics or martinis on a Saturday evening in June, just as the lawn party is wrapping up, I can hear George Will saying something to that same effect as his buddy or his wife helps him to his car--you know, in an unguarded moment. He should know, after all. He's one of the deceptive mouthpieces placed by the ruling class in order to stifle meaningful public political discourse (without the public realizing they're being gagged). O'Brien has nothing on Will. So there really can't be reform. There can only be a strangling of meaningful dialogue, with the usual failed results, as long as we the people let ourselves be controlled by the corporate chiefs, deceived by their media ministers, and frustrated by their officeholding stooges. For those in power, and their George Will-ish propagandists, reform would be like giving the manor to the serfs.