Because like most US systems, the institutions are far too fragmented and therefore overly complex and inefficient. So, a lot of the money just goes towards the

Because like most US systems, the institutions are far too fragmented and therefore overly complex and inefficient. So, a lot of the money just goes towards the overhead of logistics and managing the beast - aka, administration. It's the same problem in healthcare. We spend a lot of government dollars on healthcare. But when you have thousands of insurers and then boards per state and extremely complex billing, you're going to be putting the majority of your money into not-care.