In the U.S., healthcare is a product, not a right. Just like many other things: education, clean water, police, justice. Public versions aren't supposed to meaningfully compete with the private versions, because competently run public institutions constitutes a threat to the idea a) free markets are inherently superior b) classism is good.

On the one hand classism purports to be a motivator: if people just work harder, they can improve their class standing and buy more stuff; on the other, it's just a variation on aristocracy: some people are better than others, and they are wealthy people, it's an indisputable fact of their superiority that they can buy more and better versions of the basic things that we claim form a civil society.

If public institutions are incompetent in a democracy, how is it the culture isn't also incompetent? Incompetency and aristocracy are not civil institutions, yet we've managed to institutionalize them both by just making excuses for them.