There are no free market health systems in leading economic nations (unless maybe you take a very small niche corner of the systems)
That also does not exist in the US and hasn't in more than half a century. The US could hardly be any further away from a free market in healthcare. It's hyper regulated, and hyper dominated by government programs (Medicare, Medicaid, and dozens of other programs and agencies).
The US healthcare system is controlled top to bottom by rigid, strict government regulations and oversight. It's the way it is precisely because there is no free market at all. The corporatist interests like it just the way it is, and work with the politicians to constantly maintain that highly regulated environment: it's regulated in their favor, exclusionary of nearly all potential competition. And it's insanely expensive to try to start anything in healthcare, which favors the incumbent further.
Try starting a hospital or opening a clinic. Try becoming a doctor. Try getting a drug to market. Try getting a medtech device to market. Hyper regulation every direction you look.
Free market? Ha.
We don’t really know what a true free market would do with modern healthcare because as you say there is no such thing. Personally I think it could work for middle class and above but would leave a big coverage cliff down below because it’s not profitable to insure or treat the really poor.
The question is whether real transparency with price competition and efficiency gains would make it cheaper to then add a safely net for the poor.
https://www.google.com/search?q=lieberman+public+option&oq=l...
The issue, though, is not that it's half-assed and fucked up. It's working by design, to use legislative schemes to funnel money to incumbents and friends/donors, while still supporting the "free market" ideology, when really it's just regulatory capture.
The system is designed for graft, and it's working as intended. Those with the power to "fix" it won't, because to them it's not broken at all.
The US has the same problem in telecommunications, war/defense, and medicine. The largest vendors become integrated with the budget- and policy-makers, and the whole system exists to extract maximum value from the consumer class.
But as it is, insulin is high demand and increasing. Prices simply don't fall when demand increases.
We need to pick something. If we're going the free enterprise way we need competition, price transparency, quality and outcome transparency, more open markets, and much lower taxes. If we're going the state-run or state-insured way then we need to whole-ass it and vertically integrate and drop the state-backed private insurance hybrid nightmare.
The US does this pessimum thing all over the place. We are taxed almost like a more "socialist" country (unless you are rich enough to offshore and play tax loophole games) but do not get the benefits of one. Either cut my taxes down to Costa Rica levels or give me benefits at least as good as Canada please.