The large area hospital systems in the USA are in scope very much like the traditional ‘trusts’ of the British NHS.
I see. Yes something has to be done. I think “insurance companies” should be out of the loop. They are an expense (via profit requirement) that could be wrung out of the system. Besides insurance is supposed to be for unforseen catastrophe, not to cover everyday issues. We ALL are going to need healthcare at some point.