There’s no “cutthroat” about it. The system intentionally removes as much competition as possible. It’s cushy, taxpayer-funded socialism for the rich. (Also known as corporatism.)

At this point, China is doing capitalism better than us in its consumer industries. They actually have real competition, so fierce at times that the government worries about what it calls “involution”, or destructive competition (which Marx predicted as the end state of capitalism). Of course, its healthcare system is not run through capitalist competition like its consumer industries; it is fully state managed.

Some real competition might actually help if we’re going to keep pretending to be capitalists. Or we could move from socialism for the rich to socialism for the people. I don’t really care which as long as we move on from the current dysfunctional system.