Often "minimizing costs" for a for-profit organization means providing worse services to their customers, though.

> would you characterize Amazon as bloated, corrupt, and inefficient, despite being an effective monopoly?

It's funny you should bring this up in the context of healthcare. Amazon acquired One Medical a few years ago. Within no more a year, One Medical got so much worse. Harder to book appointments, wait times increasing, and care team not responding to in-app messages as quickly. (And sometimes being significantly less helpful than they used to be; e.g. "you don't need a recommendation or a referral for a general surgeon since you're on a PPO; just look through UCSF Health's directory and pick one". And this, after I specifically asked for a recommendation, twice. Not to mention most of UCSF's departments will turn you away without a referral, regardless of what kind of insurance you have.)

So I don't know if Amazon is bloated, corrupt, or inefficient, but Amazon acquiring what used to be a genuinely useful medical group made it much, much worse, and I assume that was all in the name of "minimizing costs".