HIPAA is a stepping-stone to single-payer and socialized medicine.
I once joined a health sharing ministry where reviews said "it requires an Olympic-class athlete in paperwork and bureaucracy". Being "not insurance" it was completely DIY and "self-pay" and begging for reimbursements after the fact.
I've also attempted to visit independent PCPs. An independent PCP who isn't part of a major health system, when they refer you out, refers you to some other independent specialist with their own process, their own IT tooling and portal, and their own claims/billing services. Now multiply those specialists by the number of your conditions, or simply the multiplicity of organs in your body, and all the fiefdoms commanded by different medical boards.
I sincerely pity any sane family of 4 or 5, because speaing for myself as an insane family of 1, the process is mind-blowing, byzantine, and frustrating by design, and the gatekeeping is exhausting but, obviously, necessary. Dealing with doctors arguably did not drive me insane, but it certainly helps keep me that way.
Gatekeeping doesn't end with single-payer and socialization, but all this back-and-forth and multiple independent systems should ideally be coalesced into one monolithic Brazil/12 Monkeys sized system.
I pity parents with sick children the most, I suppose. I mean it's bad enough for elderly parents and adult children to handle when they don't love their parents enough. But for parents to care for a sick child enough to funnel them into endless medical appointments, drugs, invasive therapies and even experimental Herr Mengele shit because it's cheap or free, feels like cruelty and exploitation being visited on that family, rather than mercy or healing. I found the Karen Ann Quinlan case (I suppose I was too young to remember when it hit the news before Terri Schiavo) and I found Karen's parents' attitude and comments to be quite poignant. It's called a "right-to-die" milestone, but I consider that the parents advocated for her right to be free from pain and distress associated with unnecessary medical treatment.
HIPAA is a fuckin' bugaboo when you're trying to coordinate care among payors, providers, billers, HIMS admins, family and friends, because all of these parties I mention are compartmentalized and the compartmentalization is nearly as fierce as military/espionage systems, except there's usually not a guy sitting next to the curtain wielding a semiautomatic rifle.