I would dispute that. My experience in the hospital side of same field has been that within the framework of the existing healthcare system it's hard to reduce

I would dispute that. My experience in the hospital side of same field has been that within the framework of the existing healthcare system it's hard to reduce costs without worsening health outcomes. The costs we can cut most easily are staff, services and supplies. Cutting services reduces revenue, nullifying incentives. Trying to deliver the same services with reduced staff and supplies impacts quality. The jobs that can be cut without reducing quality are the administrative nonsense like dickering back and forth with the insurance company, but those jobs also can't be cut without reducing revenue. It would take a change to the way we pay for healthcare to significantly reduce costs, and/or getting the cost of pharmaceuticals under control. There's a lot of fat in pharma too but that's another conversation.