the elephant in the room for healthcare is and always has been that the majority of healthcare is bullshit. or, in more technical terms, has no effect on health outcomes.
Chemotherapy is a crude and harmful way to eliminate cancer, but I know several people alive today because of it.
Without insulin injections, mortality of type one, childhood-onset diabetes would be dramatically higher.
Viagra.
Vaccines for numerous diseases are still incredibly effective and one of the most successful innovations of the 20th century.
And innovations continue. Fifteen years ago, a patient diagnosed with Macular Degeneration would be told eventual blindness was certain and the possibility of ever finding a cure was very low. Google macular degeneration stem cells to see how that has changed.
Yes, there's a lot of healthcare focused on controlling risk factors like high cholesterol and we don't really know how much that's helping, but I'm not sure I'd marginalize everything else by calling it an "elephant in the room."
Nevertheless, a large fraction of medical screens and procedures does not improve average life expectancy when people actually try to measure their impact. Intensive end-of-life care does not improve life expectancy when similarly measured.
In terms of citations, see http://papers.ssrn.com/sol3/papers.cfm?abstract_id=161308 at least for the end-of-life effects. Also see http://www.theatlantic.com/magazine/archive/2010/11/lies-dam... and http://www.nejm.org/doi/full/10.1056/NEJMoa1000678 and http://www.overcomingbias.com/2010/06/beware-active-placebos... and http://papers.nber.org/papers/W16011 and the RAND health insurance study. For a start, at least.
read this to become completely disillusioned with medicine. http://www.overcomingbias.com/2010/07/catheter-infection-law...