how big and complex the systems are now, how much money they represent, and how many interests are involved
I don't follow what you're saying. Are you proposing that the root of the problem is that it's a huge, expensive, complex industry, where a lot of people work?
Yes, I'm proposing that the high level of complexity and ambiguity involved (which originates from the intersection of the technology, organizations, politics, finances and people) in the US healthcare and health insurance system is the root cause of the problem. It is another giant machine, like the military industrial complex, for example.
I don't want to go so far as to say all huge institutions have problems like this, but I am thinking along those lines.
Some have proposed simplifying health insurance greatly by running a "single payor" system, where the emphasis is on a single health insurance entity that covers claims for every person in the US. While that might seem like a simplification in terms of process, procedure and organizations, it is very unlikely to happen in the US, and I'm not sure we could even administer that well either.
If you look at other countries that are closer to single payor, maybe say, the British NHS system - even in those countries, private insurance still exists and competes. The NHS does provide care for everyone and eliminates some issues by having a stricter control system, but the quality, availability and timeliness of that care is often called into question.
In the end, being able to dictate quality, access, and affordability (and preventing fraud) comes down to control vs. morals/ethics. Many are vying for control, for many different reasons and this often tears apart the basic industry, while morals/ethics are difficult to maintain.
Thanks for clarifying. I think however it's the wrong measure. There are industries that are as large or larger with as much if not more complexity that aren't failing to such a degree that their size is a systemic risk.
For example the US Real estate market is 7.4 Trillion, about 2X the size of the health care market with many more players and much more predicable outcomes. Finance and insurance are about the same size as well and are not terribly broken.
I don't follow what you're saying. Are you proposing that the root of the problem is that it's a huge, expensive, complex industry, where a lot of people work?