Because the US has so many successful corporations, its politics is controlled by corporate interests to an extent not seen in most other developed countries (where the political “right” tends to be the nativists and the propertied class). The “small government” concept in the US creates a political incentive for government to be ineffective and wasteful creating a self fulfilling process through which any politically visible part of the US government is terribly ineffective and the pieces that are behind the scenes are excellent. That’s why universal health care is likely to be a terrible boondoggle in the US.