there's no private healthcare system in the US, except for maybe the individual mom & pop doctor's offices.

Every other player is

- getting handouts from govt (hospital non-profit statuses from all taxes incl property taxes, payouts for invented"losses"; payor premium subsidies),

- protections from competition (PBM "discounts", Pharma IP evergreening rules, hospital requirements to approve new local competitors, payor lobbying for regs to prevent "lite" plans )

- and are very much flirting with antitrust action (payor & pharmacy vertical integration, cutting off contracts of any remaining independent doctor/vendor holdouts etc).