[nine_k]

Being more expensive for the sake of reliability / guaranteed response is fine by me. But relatively often the efficiency is so low, that, given the required scale, a low-efficiency solution becomes infeasible, prohibitively expensive.

The expense is not always monetary. While US clinics ask exorbitant amounts of money, clinics in certain countries with universal healthcare ask for large amounts of time. You need a surgery? Please wait 4-6 months. (E.g. https://expathealth.org/healthcare-news/global-patient-wait-...)

[geofft]

As a matter of amoral public policy (optimizing for "long-term survival and happiness of the people"), it's entirely possible a scheme that gets everyone surgeries with 4-6 month delays is better than one that gets rich people surgeries with 1 month delays and poor people no surgeries at all.

(Your moral system might also find that better, but morality is hard to argue.)