[rogerbinns]

No one has an incentive to fix it. Tour round the various entities that money is spent on, and try to find a single one that is campaigning to reduce their income. (eg doctors, practises, drug makers, equipment manufacturers, health "insurance" companies, hospitals). Any reduced spending is coming out of their pockets - turkeys don't campaign for xmas!

So you have a bright idea. You'll open up an excellent well run hospital, using best practises, big picture approaches, and due to all that you'll save everyone money. Of course opening that hospital will take patients away from existing more expensive providers. But it is a free country, and in other commercial sectors that seems like progress. In many states you can't do this by law. You have to show there is unserved "need" and get a certificate of need, including that existing providers are not harmed. https://en.wikipedia.org/wiki/Certificate_of_need