Loophole

You may think the entire argument is simple and straight forward. Why should there be so much trouble?

The problem is reviewed succinctly by Daniel Gilbert. To begin with, we tend to pay more to eliminate a small risk of illness than to reduce a large one, and more to insure ourselves against a scary way of dying than against every way of dying. Similarly, we will save all the members of a five-person group before we will save six members of a ten-person group, and we will save lives by pushing a trolley into a person but not a person into a trolley.

(For the last example, you may like to watch the classic talk of Michael Sandel in http://youtu.be/sHHa4ETr2jE)

Going one step forward, our mind set was selected by evolution remained little changed in the pass ten thousand years. We are specialized in understanding other minds, and are hypersensitive to the harms those minds produce. To cite directly from Gilbert:

"And so we worry more about shoe-bombers than influenza, despite the fact that one kills roughly 400,000 people per year and the other kills roughly none. We worry more about our children being kidnapped by strangers than about becoming obese, despite the fact that abduction is rare and diabetes is not. Terrorists and child-molesters are agents, viruses and French fries are objects, and agents threaten us in a way that objects never can."

For that reason, we cannot accept giving the wrong medicine once in a blue moon, but would tolerate many patients having no medicine at all. Similarly, we prefer overworking and treating patients in a haphazard manner, rather than importing one awful doctor from overseas.