Follow the money: the current system makes more sense for private insurers, pharma, and large healthcare providers who all benefit from things staying as they are.

But it’s not just about corporations. The US also built its system around employer-based insurance back in World War II, and now healthcare is tied to your job. That creates risk: leaving your job can mean losing coverage, which naturally makes people more cautious and dependent on poor employment. This also makes people more cautious about starting up a business so the economy becomes controlled in the hands of a few - and so more oligarchic

There’s also a cultural angle. In the US, “freedom” is often seen as freedom from government involvement, even if that sometimes means less practical freedom (like being unable to change jobs easily), and the individual spending more on insurance than they would on taxes.

So it’s not one single reason - it’s money, history, and mindset all reinforcing each other.

Rigidity and social control also show up in other countries with strategies like high housing costs.