> It just sounds completely broken over there and I'm not sure I will manage to wrap my head around it.

Agreed. But that's the way it is, and it's important to understand why it's this way.

When Europe and Australia adopted national healthcare systems, the industry was ~3-5% of GDP. So at that point it wasn't politically strong enough to resist either nationalization or strict controls.

Then healthcare mushroomed in size, being ~10% of GDP in Europe and 20% of GDP in the U.S.

So now, when you try to do the politics that the europeans did, it doesn't work. The industry is too powerful. Merely blaming the US for not doing what Europe did misses this essential point.

There are millions of nurses, lab techs, administrators, and doctors, and they have money and they vote. So the left keeps looking for some villain -- greedy insurance executives, Wall Street, Evil Billionaires, etc. And basically refuses to understand that these are not the ones standing in the way of reform. It's the 13% of our labor force that earns 20% of national income, and these are not the same easy targets that the left can attack, because they are a large portion of the US middle class, and are core Democratic constituencies.

That's why healthcare reform in the U.S. always focuses on having the government pay some of the costs charged to consumers rather then reducing the costs of providing healthcare. E.g. more subsidies for this bloated industry, which only results in costs rising even more, and then calls for even more subsidies when people can't afford to pay the costs. When what we should do is fire 50% of the staff and cut the pay of those that remain by another 50%. That's the only way to get affordable healthcare.

And you have a similar problem with higher ed.

Yes, the healthcare system is politically powerful in the US, but also we have a culture war that has existed since the founding of the country such that half the country considers is highest political priority avenging slights and punishing the other half. Any sufficiently powerful minority can leverage this state of low level war to prevent any legislation that might harm them. Someone wants to prevent hog waste runoff from CAFOs? Inflame the culture war! Medical pricing is out of control? Inflame the culture war! People are being destroyed by payday lending and someone wants to address this? Inflame the culture war! Someone wants to reduce our profits by forcing us to internalize the costs of methane leaks? Inflame the culture war! There are a bunch of people itching to beat up their neighbors. Tell them that the people who want to fix something are their enemies and away they go. That is why the Land of the Free is such a shitshow.

I think we can all agree the US healthcare system is broken. The above describes exactly why it can't just be "fixed"; only after taking those steps would moving to a universal solution make sense. No one, including healthcare workers, wants to be downsized or get a pay cut.