Hi Scott,

The collapse of the heath care system may be related to problems of institutionalization that Illich describes in his many books. Deschooling Society is probably one of his best known works, and while this is often seen as a critique of the education system, in fact, education merely provides the example of an institution. Illich’s thesis is that institutions eventually defeat the purpose for which they are created. They do this for reasons you describe – centralized authority eventually causes them to collapse under their own weight. He proposes more organic, populist or “convivial” structures. See his “Tools for Conviviality”.

Here’s a little about that: http://steve-wheeler.blogspot.com/2014/03/tools-for-conviviality-illich-and.html