I'm skeptical of claims that this waste doesn't translate into the higher level metrics. The claim is that the size of the pot of money to be split is determin

I'm skeptical of claims that this waste doesn't translate into the higher level metrics. The claim is that the size of the pot of money to be split is determined by the willingness of consumers to pay. Which is determined by their wealth. Therefore the inclusion of a lot of administration changes the split of where that money goes. More administration = less money for nurses and doctors. Less administration = more money for nurses and doctors. This fits observed behavior in other places. Your potential client has a problem and a potential budget for the solution. Clients are remarkably indifferent to how that budget is split up, as long as a solution to the problem is worth spending the budget. Here is the example that originally brought this point home to me. When Oracle moved from Solaris to Linux around the year 2000, it was able to charge more money for the database. Why? Because companies were willing to spend money on Oracle that previously went to the hardware and operating system. This incentive to open source the complement of whatever product you're providing is one of the reasons why so much money has been invested into creating open source.