There is no simple explanation, but an important issue is that there is no price discovery mechanism or system pressure for efficiency. You also may not know that the US healthcare system is also an elaborate jobs program. Walk into any hospital and you will see 5-10 mostly young women doing basically nothing. I don’t know why the powers that be decided that the US should divest itself from any useful work, but here we are. Now we’re a couple generations into this social experiment by “smart” billionaires and their courtiers, and the military industrial complex is begging the Taiwanese to hold our soft hands and teach a blossoming generation hipsters and resentful immigrants how to build the computers we invented. We had a good run, but we’re Rome circa. 400-500 AD. Don’t let the marketing in Venezuela fool you. I’m just hoping the robots give us a few more decades of working plumbing.