When I'd go to the doctor in Italy, I'd basically go the waiting room and take a number. When it was your turn (some doctors were pretty fast - 10/15 minute wait - others were slow) you'd go in and see the doctor. No other staff needed.

Compare and contrast with a US doctor who has a number of support staff, one of whom is probably full time doing nothing but insurance paperwork.

IDK all the details, but when the US looks more bureaucratic than Italy of all places... something isn't right.

Of course it's definitely a complicated system and more expensive end of life care is probably part of it too.