In my experience, it’s often even worse - there often isn’t even any significant profit, at least not in any coherent, centralized way. There are a lot of individual players who can be pointed out, but none of them individually is ‘the problem’.

Absolutely massive amounts of value is destroyed (and patients harmed) just doing super inefficient shitty processes because no one has the ability or incentive to do any better at a systemic level.

Everyone in the system who has a degree of control gets paid very well keeping the wheels turning and consuming cash.