It’s also geographically distributed. Substantially all congressional districts count a healthcare system as a top-5 employer. Those 70k/yr butts-in-seats admin jobs are occupied by voters, making them difficult to eliminate nationally. You’d have to go down to the state level at least to get anything done.
I think it’s because Americans been taught that were democracy, not a federal system, but that’s exactly where we expect to do these kinds of reforms. The federal government could reasonably set certain regulatory requirements. The states would need to make sure that any provider within it conforms to the federal levels, you know like auto manufacturing and exhaust emissions. Seems doable. Unfortunately we’re gonna have to wait for the boomers to die because they’re the ones that have gotten theirs and they’ve screw everyone else. Also, unfortunately, the millennials are gonna have to take it on the chin like we have for so much else and realize there is going to be some lost jobs.