> What exactly are each of these private companies doing that can't be automated and consolidated?

After dealing with government for various healthcare services I can think of absolutely nothing more horrific or dreadful.

Capitalism works, because people compete for customers. I've very happy to have lots of insurance companies competing.

I think it was Mitt Romney (not sure) that had the idea of just giving everyone a lump sum to buy insurance and let them buy it where ever they please.

A healthcare voucher system I guess.