I saw Jim Clark (of SGI and Netscape fame) talk one time about his new healthcare startup (Healtheon). He said something insightful that captures a lot of why it's hard to get things done in general: one person's inefficiency is someone else's bottom line.
And someone else's bottom line is also the wages of friends and neighbors.
Last I heard healthcare is like the only employment sector that's seeing real growth right now.
The flip side of Bezos' "your margin is my opportunity". But that's for competitive markets, not for heavily regulated multi-party setups with minimal competition. That's the real wonder of American healthcare, as it manages to neither be a good market, nor to have regulator mercilessly going after the largest profit centers. Near the worst of both worlds.