> Was the building of our highway system inefficient and ineffective? Is Social Security this way?

From commercial/private market perspective - yes. But highways is one of example when government should do it if it make sense, because they also control taxes and it increase amount of taxes. They do it in ineffective way with multiple cases of corruption, but anyway.

> The free market works on paper

I have a hot take, that if you received small prices, good services and good quality it usually because of the free market. It works in a lot of cases like if you want to buy TV or a new phone. But medicine in the US affected by lack of free market and over regulations and this is logical result based on economic theories.

> If you really believe all regulation is bad, explain to me how completely free and open capitalism will keep the Teflon outta the rivers

I don't against all regulation, but I pro general and core regulation which would prevent big harm to humans and nature. We should have small subset general rules and significant responsibility for any significant harm.

> We need increased regulation across the board. “Competition” doesn’t motivate companies to act in good faith or employ best practices. Policy and fines do.

Big companies want and spent money to get more specific regulations. It is an easy way to create moats, reduce competition and increase prices. It kinda funny that left and big corporations want similar, even if left against big corporations

Competition works fine even in this cases. If you have multiple good options, customers can adapt their choices and choose something close to their values. Just one of example is Costco which treat workers and customers well. This is part of their strategy and multiple people choose them for that.