Our system of commercial medicine, dominated by private insurance, regional groups of private hospitals, and other powerful interests, looks more and more like a numbers racket. We would like to think we have health care that incidentally involves some wealth transfer; what we actually have is wealth transfer that incidentally involves some health care. In America today, malady is physical illness and the political evil that surrounds it. We are ill in a way that costs us freedom, and unfree in a way that costs us health.
Though there really are a lot of people who think of medical care as being just another service purchased in the market. “Health care is a purchase like any other. Individuals should make their own best deals in the insurance market with minimal government supervision. Those who pay more should get more. Those who cannot pay must rely on Medicaid, accept charity, or go without.” from https://www.theatlantic.com/ideas/archive/2020/08/new-gop-platform-authoritarianism/615640/
One interesting aspect of this is that a similar attitude has been very successful regarding *feeding* the poor — we give the poor money (food stamps, which are very close to cash), they buy food with it, they eat it. The production and distribution of food is extremely capitalistic and industrialized, and basically nobody starves in the US, and the overhead costs of feeding the poor are quite small.
I suspect the difference is that while people naturally buy food that meets the requirements (provides calories), all the studies show that peoples’ choice of medical care (when they have a choice) is based not on “medical outcome” but based on “concierge experience”, i.e., how socially pleasant the experience is as a consumer. (And all historical anecdotes say that the doctors that get rich have great bedside manner.) And though the US medical industry has a lot of deficiencies, we’re ahead of the world in terms of “If you have the money, we will treat you very pleasantly.”