You can figure try to figure out the "why" for specific cases but it's tedious work and comes down to subjective opinions that can't be generalized to other cases. The theoretical worth of the shadowy middlemen (whether they gov't or insurance companies) and where the blame lies can be debated. All these arguments rely upon theoretical simplifications of very complex systems--meaning they are almost impossible to model.

What's more important is the "what" as in what are our alternatives. Luckily, we have tons of empirical data from other countries and they all tell the same story: America pays more money, with poorer results.

So why not just copy the models of other countries?