John,

Cost of patient care has become a huge issue in the US, with payor compliance occupying as much as 45% of a physician's working hours. With that level of administration, bureaucracy appears and locks in benefits for themselves as they always do. So medicine comes more and more to resemble reading of signals from machines rather than interacting with patients, and the cost keeps going up.

Of course medicine is a guild, but it has to be if you want physicians and facilities to be accountable. To be licensed as a medical doctor is a massive responsibility and the public needs to know they are dealing with somebody who trained for years and has been licensed by a jealously exclusive guild, not somebody who decided they want to be an expert without experience or science to justify their loudly voiced opinions.

I'd also observe that patients want to have a special relationship with their physician who they want as their advocate against a suspicious health system focused on saving money. Increasingly this relationship is perverted with payors and administrators demanding first loyalty to the system/facility rather than to the patient. The results always increase cost.