- It's primary purpose it to bill people, not to cure people. It is doing really well at this.
- The secondary purpose is to provide incredible care to the richest of people. It does pretty well at this as well. Not as good as it used to, but still probably good enough.
Pretty far down the list of priorities is to heal poor people and make sure they don't fall sick again. It is not something most people give a shit about. If they die, they hey they should have been rich instead.
It is slowly changing with the middle class that was rich enough to get good care being eroded away enough to realize no-one gives a shit about them but they have enough voting power that people have to pretend (similar situations happen all over the world, just maybe not with healthcare).
Take US healthcare. There are a lot of models for how you can deliver universal healthcare to all your country's residents. They're all different. They all have problems. They're all better than the current US situation. They're all cheaper for a start, most of them have better outcomes by some measures, often by almost all measures.
There was plenty of room for two political parties to have ideological disagreements about how to deliver universal healthcare to Americans as a result. Which examples to follow and which to reject.
But the Republicans didn't do that. They decided the hill they wanted to die on (or at least, for some of their voters to die on) was the ideological rejection of universal healthcare as a goal. They would literally tell people it can't be done, despite the fact that every comparable country already did it.