[saltcured]

Understood and agreed. I admit I was feeling a bit pithy with that comment.

I shouldn't really have referenced "replace" at all, but rather "optimize". And not targeting middle management but the whole non-medical structure above. This is where I think most of the waste in our modern US medical system lives.

But I understand it is still mostly a half-baked concept. We'd need a revolution far outside of just some management system. I believe it's the whole enclosing system that is rotten and driving medical costs away from the actual encounter costs. Profiteering, risk management, regulatory capture, etc.

I woudl argue there was a point, long ago, where these things have taken on a life of their own and no longer serve the need of improving care outcomes and the actual medical cost-benefit tradeoff we should be optimizing in a just and caring society.