Insurance company incentives are for you to die as quickly as possible with as little treatment as possible after having paid as much as possible. And they set things up on that basis.

The thing about single-payer is not really so much that it's more economically efficient; it's that it has decisions being made by people whose pay and promotions can -- not will, but can; it's really hard to prevent the measure-with-money mindset -- rest on health outcomes. (Which is how flu shots went from special-request to public-clinic to every-pharmacy here over a decade; the actuarial case was compelling.)