Our society places an enormous value on "competitive obfuscation".

As an obvious result, our society does an incredible amount of work maintaining that obfuscation.

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I've heard estimates that 20% (1/5th) of all healthcare-related spending in the US is overhead from insurance determinations, paperwork, etc., and that that 25% (25%/125%=1/5th) extra spending (relative to 100% of the rest of healthcare expenditure) does not exist in single-payer healthcare systems, like those used in Canada, Germany, and every other developed nation in the world.

What do we get from that extra spending? What substantive difference does that obfuscation provide?

The main difference I see is "explicit opportunity cost". Instead of deciding ahead of time that we will pay for any arbitrary healthcare need (as a single-payer program), the opportunity for each individual healthcare act is given a price, and groups of priced opportunities are provided by subscription-based insurance plans.

Every person has to find, apply for, and pay for an insurance plan that will meet their current and future healthcare needs.

Because that is explicit, there is leverage available to manipulate each opportunity cost, and even the opportunity of each person to have that opportunity provided to them.

So what does that leverage even look like, and who is using it, and for what purpose?

Politics. Instead of care being determined by your doctor, access to each type of care is explicitly made available (or unavailable) by your insurance plan. That's a huge attack surface for political motivation.

There is currently a dextroamphetamine (Adderall) shortage in the US. The other day, I went to my pharmacy to pick up my prescription for 30 generic Concerta (methylphenidate extended release, another stimulant medication used for ADHD), and learned that all they had left were 16 brand-name Concerta. I was lucky enough to have that covered by my insurance. Many different insurance plans would not have provided me that opportunity.

Why is there a shortage? Despite a significant increase in ADHD diagnosis last year, the DEA refused to raise the limit of Adderall that can be legally manufactured. Why? Because there is a long-standing political conflict between stimulant addiction prevention and ADHD treatment, and the DEA is positioned at one side of it.

That same political conflict is why some insurance companies have outright refused to include coverage for stimulant medications. Even without a nationwide shortage, some people have found themselves stuck in a position where the opportunity for medication is held just out of reach by the political decision of their insurance company, or the lack of access to insurance at all.

The same pattern can be found with practically every type of medical care that is politically controversial: contraceptives, abortions, hormones, etc. Even if you can't get a legislative ban, there is still leverage available to obfuscate opportunity itself.

When conservative politicians argue that a single-payer program would be "too socialist for America", the substantive difference they intend to preserve is the political leverage that is baked into the system we have; the political leverage that allows politics to restrict our medical care without a single vote.

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That's just one example. This pattern is everywhere. The only answer is social objectivity. It's a hard problem.