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If there is to be some control on healthcare spending, and/or policing of fraud, someone must approve and decline payment for services. This is the function currently fulfilled by the insurance companies. You can eliminate the companies, but anyone performing the service will consume some amount of overhead.

Well whatever is going on in America[0] it just isn't working.

https://en.m.wikipedia.org/wiki/File:Life_expectancy_vs_heal...

It isn't intrinsic. In any modern healthcare system, someone has to manage resource allocation and risk pooling. Some countries have government perform those functions, which can be more efficient but isn't necessarily so. In the USA, even the government run Medicare health plan outsources much of the administrative work to for-profit companies.

@nickff shouldn't that be a not-for-profit watchdog capability then? Not a massive money making middleman?

(Can't reply that deep)