- The majority of states still maintain "certificate of need" laws for new hospitals, ambulance providers, etc.
- The AMA holds a state-enforced monopoly over physicians.
- Many states still limit NPs/PAs, requiring physician supervision for things for which those people were trained.
- Lack of interstate reciprocity in licensing means mobility is constrained and supply can't follow demand.
- Costly medical equipment usually requires first-party repairs; mfgs claim a third-party modification (repair) constitutes remanufacturing under FDA regs.
- Stark law makes e.g. physician/hospital value-based care arrangements very hard. It's quite strict and everyone has to tiptoe around it a bit.
There's also the huge problem of malpractice insurance costs due to insane tort settlements. Awards need to be capped yesterday because it's too easy to talk a jury into bankrupting people over things that legitimately just sometimes happen.
I'm guessing others could give you an even better list. Some of those are a bigger deal than others but it's a huge issue. Insurance net margins just aren't high enough to blame it and drug costs aren't enough of our total healthcare spend to be at fault.
It comes down to humans being too expensive. There remain many areas of care where we can't cut man-hours down without sacrificing safety and quality. As such, we should reduce the insane byzantine co-ordination and compliance overhead.