You are correct, you are just smart enough to be dangerous
There are plenty of reasons hospitals are not profitable. There are laws requiring us to treat who shows up to our ED. Hospitals have to absorb those that do not have insurance and this costs much more than insurance squeezing things. Look around the country and see why hospitals are going out of business. They are usually in rural or underserved areas and have too high a proportion of uninsured. If uninsured goes up in the US, more hospitals will close.
The hospital systems that are successful are usually not because they have better outcomes. They control their market better and do so at the cost of humanity. They have administrators that are good at altering the numbers to make them look good. If you took the top 10 hospitals in US news whatever...they all do this. Did you know that you can "erase" a bad outcome if you flip a patients bed from an inpatient bed to a hospice bed after a bad outcome on a surgery? It looks like they were discharged alive to the numbers that matter for rankings but they could have died minutes after that clerical trick. The "top" hospitals are doing this.
Did you know that Cleveland Clinic makes every effort to hide their emergency room to avoid serving the very poor community that their campus is in (which they had to have in order to continue in the community)? Did you know that Mayo and other profitable systems take preference for private insurance over medicare and medicaid? Why are some of the worst/underserved neighborhoods in Baltimore around Johns Hopkins?
You can make a hospital system profitable but that does not translate to better outcomes. You can also lose the purpose of healthcare in the process. You are not serving the community, you are hurting those most in need in the name of profits. These profitable systems abandon the most needy in their communities and represent part of what is wrong in our system.
