The sum of money contributed by employers, by unions, by state and Federal payors is finite.
There have always been middlemen in health care. When I started in 1982, most of them were helpers, getting me up to date references, helping surgeons get new or hard to find tools, yes, bringing in lunch once in a while.
But Skynet has become self-aware. An army of MHA/MBA people has arisen, and in response to the explosion of Federal and state rules, regulations, and metrics, the share of the finite pie going to EHR administrators and tech support, Quality Performance directors, Federal partnership associates, Rev Cycle managers, utilization coordinators, compliance teams, Pharn=macy Benefit Managers and so on keeps growing and growing.
The corollary is that the funds available for patient care are shrinking and shrinking. The system is in crisis.
Ther are sectors like cosmetic plastic surgery which can operate and thrive on more or less market principles. But the system as a whole cannot as long as the number of straws in the drink, the number of non-patient care mouths to feed, keep up their relentless growth.
Nationalization is inevitable. Look at this graph and tell me how this ends:
None of these roles existed ten years ago.