Instead of fixing the leaks in the plumbing we're just increasing flow rate at the top of the system. Right now the medical-industrial complex is a business that happens to provide medical services as a byproduct.

Fee for service encourages more medical intervention. It makes break-fix work more profitable than trying to address root causes. Each layer and sub-sector is for-profit. The supply of physicians is capped. Vertical integration can reduce the double margin problem. Specialists are paid more than general practitioners. Surgeries make more money than non-surgical treatment.

People expect someone else (their employer, the government, the rich) to eat the cost of healthcare. Third party payment makes patients price-insensitive. People unironically expect a cure for death. Drugs and medical devices are expected to be perfectly safe. Americans lead unhealthy lifestyles. Soda is the default drink in cafeterias and at parties. Car culture and car only infrastructure promotes physical inactivity. Kids are not allowed to roam. When there was a push to promote healthier school meals there was immense pushback.