False dichotomy. Yes, emergency rooms are a marvel of modern planning and materials. But just because they are impressive does not mean they need be expensive, or that such efficiency must be difficult to implement. The initial costs for the mediine is all front-loaded, in the R&D. The actual manufacturing of previously discovered medicine is cheap and trivial. The same is the case for many of the efforts of nurses and doctors (not to belittle their jobs), but they aren't doing R&D. They are following memorized checklists of knowledge, triaging based on information that was discovered elsewhere, then imported to their classrooms. All of this cost is also front-loaded.

Grifters, middlemen, and oligopolies are why healthcare is expensive in America. There is no reason we can't fund expensive R&D and also get cheap medicine.