Wouldn’t lowering overhead costs be an obviously positive outcome?

Ah, but there’s the rub: All this overspending creates a lot of employment — and moving toward a more efficient and equitable health care system will inevitably mean getting rid of many administrative jobs. One study suggests that about 1.8 million jobs would be rendered unnecessary if America adopted a public health care financing system.

So what if some of these jobs involve debt collection, claims denial, aggressive legal action or are otherwise punitive, cruel or simply morally indefensible in a society that can clearly afford to provide high-quality health care to everyone? Jobs are jobs, folks, as Joe Biden might say.

Indeed, that’s exactly what Biden’s presidential campaign is saying about the Medicare for all plans that Senators Elizabeth Warren and Bernie Sanders are proposing: They “will not only cost 160 million Americans their private health coverage and force tax increases on the middle class, but it would also kill almost two million jobs,” a Biden campaign official warned recently.

Note the word “kill” in the statement. That word might better describe not what could happen to jobs under Medicare for all but what the health care industry is doing to many Americans today.

Last week, the medical journal JAMA published a comprehensive study examining the cause of a remarkably grim statistic about our national well-being. From 1959 to 2010, life expectancy in the United States and in other wealthy countries around the world climbed. Then, in 2014, American life expectancy began to fall, while it continued to rise elsewhere.

What caused the American decline? Researchers identified a number of potential factors, including tobacco use, obesity and psychological stress, but two of the leading causes can be pinned directly on the peculiarities and dysfunctions of American health care.

The first is the opioid epidemic, whose rise can be traced to the release, in 1996, of the prescription pain drug OxyContin. In the public narrative, much of the blame for the epidemic has been cast on the Sackler family, whose firm, Purdue Pharma, created OxyContin and pushed for its widespread use. But research has shown that the Sacklers exploited aberrant incentives in American health care.