All true, but we have good models of integrated care in the US; Kaiser, Cleveland Clinic, Mayo…..and smaller regional ones, like Kelsey-Seybold in Houston. Integrated systems eliminate duplicative services and rework, taking a ton of inefficiency out of the system.
From there, the patient can still be enabled to shop the system if they wish. The costs of a procedure are almost always going to be higher in a larger city than they are in a mid-tier one; if I am incented to save, say, a thousand bucks by using an exurban facility that’s 30 miles away rather than the one near my urban home, many people will do so.
We can get there, but it’s a tough road ahead.