This is precisely it. This is how you end up with this colossally large ecosystem where things like surgery centers proliferate — with every specialist operating as an outside extension or even an inside extension and costs skyrocket for customers because you just have some many people involved in the chain of care. To boot, a lot of these networks operate their partner organizations through backend ownership groups.

Obamacare tried to fix this by making the entire chain of care responsible for patient satisfaction and outcome and making rate payment contingent, but it really ended up consolidating so much of the industry into integrated and profit maximized network-of-relationships so that the downside can be managed (and the backend financing consolidated similarly, though in many different ways). All of them, to your point, really optimized for extraction.

I spent some time looking into generic drugs and compounding operations as well and we really don’t have many left in the West. It’s concerning. No money left for the basics and the system isn’t very robustly built for basic operations (read the boring, lower paying part of medicine that keeps us all alive every day).