>The system is deeply irrational and has many inefficiencies in it, but too many groups have some vested interest in keeping their part of the system intact, so nothing changes. Just as one simple example, Duke University Hospital has 900 beds but 1,500 billing clerks because it deals with hundreds of health insurance organizations, all with different rules. If there were a single payer, a large piece of the 25% would vanish, but for ideological reasons, Republicans are opposed to a single-payer system, even though it would save billions of dollars every year.
http://www.who.int/healthinfo/paper30.pdf