I've never heard anyone defend the current status quo as acceptable, but the problem I see is that it's a profoundly byzantine system wherein every participant

I've never heard anyone defend the current status quo as acceptable, but the problem I see is that it's a profoundly byzantine system wherein every participant has many other people to point at and blame, while outsiders have extreme difficulty even figuring out where to start to untangle the mess. Case in point, one of my cousins works in Pharma. He has no end of stories of hospital administrators doing wasteful things, and insurance companies screwing doctors and suppliers, of doctors running rackets, and of course (his opinion) that huge numbers of Americans get medical treatment and then disappear, never paying their bills, and so the whole system is designed to extract 2-3x from the people who _do_ pay in order to cover the ones who don't. Meanwhile, this same person (at a different time) will tell you with a little twinkle in his eye what a good business it is selling pulse oximeters. Again in his words (so I don't know if he is exaggerating or if this is accurate)... His company has exclusive deals with a bunch of hospitals where they are the only supplier. They make the little plastic devices in bulk for pennies apiece, then they charge several dollars for each one. But then, most "cleverly" the company worked the product through FDA such that it is only authorized for "single use." So while in real life the device could easily be sanitized and reused many many times, instead every hospital needs a constant supply of these which they use once and dispose, resulting in a constant trickle of small purchases that add up to a huge business. He says this from the living room of his huge, very nice house, and gestures around as if to say "and that's what pays for all this." In short, I think the industry is dominated by people who are there to make money and _are_ making a lot of money, and they don't want that to change. Ie. pretty much normal humans just as deplorable as the rest of us. Thus I don't see the harms they are inflicting on society being fixed until the remainder of society organizes and says no, shutting down the racket. But unlike most industries, screwing up the medical system has life and death consequences, so to date when the rest of us get angry and propose a dramatic change that should help, we are easily cowed by the doctors/nurses/pharmacists/etc. who scream "it can't work, people will die!" Thus I am very, very pessimistic that a democratic society is capable of fixing this kind of deep corruption. If it is ever fixed, I suspect it will only be when the system collapses under its own weight.