You've probably seen this report:
The Federal Healthcare Exchange was able to do the job much cheaper than the state-run exchanges. Ironically the states that benefitted the most were those that refused to participate and therefore were served by the Federal exchange.
Personally I think that the insurance companies that got 8.1 million signups should be billed for the cost of those web sites. The bill should include a note saying, "Covered costs: $0. Your responsibility: $X billion." Hilarious, right? (I know, I know... don't quit your day job.)
But we, as sysadmins, know the cost-saving power of centralized IT. Build a system once and use it for as many users as possible. It just plain makes sense.
Now that people are seeing proof that economies of scale saves money in healthcare, imagine other ways we could reduce the cost of medical care in the U.S. without affecting the quality. Who would have predicted that? Oh yeah... Anyone paying attention!