There's an excellent book (well it had bad reviews, actually, because it was perhaps overly detailed and tedious, but I enjoyed it) about the Gemini project called On The Shoulders of Titans. Reading through the notes of how NASA interacted with contractors was terrifying: here's some money to study something. Turns out it was very subtly different from what NASA had intended them to study. Here's more money to do another study. Now here's money to build a prototype. Oh you're 90% done and out of money? Here's twice as much money. Oh now you're 99% done and out of money? He's the same amount again. Oh it doesn't work but you can argue it's NASA's fault? Here's more money to start over. You're done? Actually we're gonna scrap this particular mission objective now.

Space X owns something much close to an end-to-end objective: it's not a study, or a build, it's getting the thing to orbit, end of story. I think if you could set up the situation so that a company owns the end-to-end story of your health, things might be better off. That sounds more like Kaiser Permanente and my impression is that's exactly what happened. In reality our healthcare system is typically more like Gemini: contractors, tons of regulations, but none of them really own the end result so it's a public/private mix of bureaucratic mess, misaligned incentives, and buck-passing.

Part of that is it was very very hard to know back then what was needed and what would work. Now a lot of the fundamentals are well hammered out and the big challenge for SpaceX was the landing not figuring out how to build rockets in the first place.

Also the ACA did have some successes in doing kind of what you're talking about. There were incentives in there to avoid readmittance before 30 days and to all appearances it's been a success.

https://www.statnews.com/2016/12/27/obamacare-success-penalt...