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The real problem is with the weird indirection of the US government providing payment to doctors/hospitals/pharma through subsidies, tax breaks, and tax penalties granted to or extracted from citizens that can only be spent at private insurance companies or mitigated by spending at private insurance companies who then, in turn, pay for your healthcare.

The sheer complexity of this rent-seeking indirection makes keeping track of the millions of distinct participant-instances that can play out in hundreds of different ways, involving integrating tens of massive legacy systems with new, flexible business logic (for a law in flux), impractical.

With single-payer, they could have scrapped the vast majority of this complexity.




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