Waiting lists are rationing. People have had their lives rationed away by Medicare, although the establishment press pays little attention to this grisly fact. Waiting lists are an attempt to preserve the illusion of free care by chiselling on the promise of unlimited care. It was promised that Medicare would be at government expense. So Medicare officials treat the sick with all the tender solicitude shown by the post office to its customers.
Bureaucratic management has a big impact on costs.
Profit-seeking management always has to be concerned about pricing itself out of the market, so it keeps an eagle eye on costs. Bureaucratic management may go through occasional spasms of cost-cutting, but only when political outrage reaches the boiling point. Then it's back to free spending as usual. The bureaucracy burgeons while sick people languish on waiting lists. We're so familiar with the evils of bureaucratic management in other industries that the fact is beyond doubt.