That's one of the obvious reasons why immediate, dramatic reductions in medical cost for the country as a whole are very, very difficult. Sure, single payer costs less and is more efficient. But what about the people who are doing those "inefficient" jobs now? It takes time to change the system in a way that isn't hugely disruptive.

Cheers,
Scott.
(Who remembers talk of anti-cavity vaccines that would be ready by 1990...)