Healthcare is constrained by regulation.
It's not enough to be good at a task. We also need to be allowed to perform it.
These rules, while designed for safety, are essentially made up. They're controlled by governing bodies, and are thus prone to corruption.
Why is this important?
Because if we're compensated based on our jobs, and our jobs are dictated by corruptible rules, then the rational move is to accrue political bargaining power. All of a sudden, it makes sense to play zero-sum power games, rather than focus on delivering better care.
Thankfully, reality is not quite as bleak.
The people I've met in hospitals are making huge sacrifices, despite personal cost, for the benefit of their patients. This can't be overstated.
But over time, incentives win. Focus shifts towards politics, and the game becomes further and further disconnected from reality.
At the limit, any earnest people are demoralised into submission.
How can we do useful work, in spite of this?