higher costs. In the United States, a person is more likely to receive open heart surgery after a heart attack than in other countries. Medicaid pays less than Medicare for many prescription drugs due to the fact Medicaid discounts are set by law, whereas Medicare prices are negotiated by private insurers and drug companies. Government plans often pay less than overhead, resulting in healthcare providers shifting the cost to the privately insured through higher prices. Composition of economic sectors The United States is the world's second-largest manufacturer, with a 2013 industrial output of US$2.4trillion. Its manufacturing output is greater than of Germany, France, India, and Brazil combined. Its main industries include petroleum, steel, automobiles, construction machinery, aerospace, agricultural machinery, telecommunications, chemicals, electronics, food processing, consumer goods, lumber, and mining. The U.S. leads the world in airplane manufacturing, which represents a large portion of U.S. industrial output. American companies such as Boeing, Cessna (see: Textron), Lockheed Martin (see: Skunk Works), and General Dynamics produce a majority of the world's civilian and military aircraft in factories across the United States. The manufacturing sector of the U.S. economy has experienced substantial job losses over the past several years. In January 2004, the number of such jobs stood at 14.3 million, down by 3.0 million jobs (17.5%) since July 2000 and about 5.2 million since the historical peak in 1979. Employment in manufacturing was its lowest since July 1950. The number of steel workers fell from 500,000 in 1980 to 224,000 in 2000. The U.S. produces approximately 18% of the world's manufacturing output, a share that has declined as other nations developed competitive manufacturing industries. The job loss during this continual volume growth is the result of multiple factors including increased productivity, trade, and secular economic trends. In addition, growth in telecommunications, pharmaceuticals, aircraft, heavy machinery and other industries along with declines in low end, low skill industries such as clothing, toys, and other simple manufacturing have resulted in some U.S. jobs being more highly skilled and better paying. There has been much debate within the United States on whether the decline in manufacturing jobs are related to American unions, lower foreign wages, or both. Products include wheat, corn, other grains, fruits, vegetables, cotton; beef, pork, poultry, dairy products, forest products, and fish. Energy, transportation, and telecommunications Transportation Road The U.S. economy is heavily dependent on road transport for moving people and goods. Personal