I think there is an EXCELLENT simile in this, which goes to the heart of it all. That is, that there are inescapable consequences, to the choice of approach made. It's related to what I alluded to earlier, where if we make final cost-per-unit, the only measure of medical success, the natural result will be higher "unit replacement." In the medical arena, that means that if maximizing the profits of the vendors and the insurance companies (the pure market-forces approach) is the method selected to measure success, the necessary result will be more "units" (i.e. patients) needing to be "replaced" (i.e. left to die, or simply suffer their illnesses).

When it's inanimate objects like trucks, we can shrug our shoulders and say "well, it's just a matter of which kind of paperwork you want to do." But when it's human beings, we'll be dealing with life and death. Literally.

Thanx for the call out. I find many things about health relates to mechanic repairs.

The quote is only to add that auto and truck repair is more that "just paperwork".
I was a shop manager for multiple facilities over the years.
The technician is "Fix Trucks".
The shift leader is "which trucks need fixed by when".
The manager is "why fix trucks"
His boss is "why spend so much money fixing the damn trucks?"

Each level of the process has different agendas and criteria to be met.
All the while, the trucks have to stay on the road racking miles or nobody has a job anymore.
No trucks, no money to spend fixing them.
The concept is Ouroboros,the snake that eats its own tail.

Is this topic also discussing an Ouroboros condition?

Doctor says "Fix Patient"
Insurance company says "Which patient to fix by when and why are you fixing THAT patient. Why are you fixing this patient this way? Find a different way to fix this patient that costs less."
Doctor says "Fix Patient"
Meanwhile the patient stays sick or gets worse until the higher ups figure out what they are going to do.

At least a truck doesn't die from paperwork issues.

Early in my career I worked for an undercar shop. Exhaust, brakes, suspension, alignment, stuff like that.
If I was doing a simple oil change and noticed bad brakes or a broken suspension part, it was my duty as a human being to notify my customer their lives may be in danger.
I have had that happen with a young woman and her child.
Her brakes were worn metal to metal, very dangerous.
She only had limited funds. I did the labor for free. She became one of my best customers.

We all want to live.
We all want to live in a healthy state.
We trust doctors with our lives (literally).
We don't go to the insurance company for medical care.
Why does the insurance company get such influence whether we get care or not?

What's the point of having mechanics if you are not going to give the money to fix trucks?
Why not just hire temps and just replace certain parts with cheap parts till its fixed?

"Oh, an injection pump? That is very expensive, put in new injectors".

"But sir, injectors won't fix the truck".
"A new injection pump will fix the truck".

"Well, you fix it anyway you want but a new injection pump will not be bought and we will not pay you to put it in".
Mechanic says, "screw that, if you don't care about your trucks, why should I"?
"I'll just put it outside on the deadline till you decide to let me fix it".