X is the amount of medical care available
Y is the amount of medical care wanted
If Y < X there is no problem with any of the systems. And, obviously, a certain amount of inefficiency doesn't affect patient care. Plus, perhaps relevant today: when shit hits the fan we can scale up available care quickly.
If X > Y it doesn't matter which system you choose, someone will go without. You can change who goes without but you cannot fix the system by changing the method of dividing care.
Can things be somewhat improved with better organisation? Sure. Probably. But let's not overestimate it either. Let's take a dream scenario: optimal organisation can make 20% more care available. How much more care is wanted? I think we can safely say the US population wants 200% or more than the current system provides. Whilst nobody's opposed to improving organisations, it cannot fix the problem.
Fixing the problem is something you can only do by doubling the medical training available. That'll be a lot of extra dollars, none of which go anywhere near patient care for at least 10 years, so I would expect a lot of strong opposition from a lot of sides. But it's the only way to fix things.
