US healthcare is a market but not for patients. Insurance, employers and hospitals negotiate a lot. But people who get employer based insurance just have to accept what they are given. Pretty crazy.

Don’t most large employers essentially self insure? They only outsource the administration to insurance companies, not the float.

Sure. The point is that the employer does all the selecting of options and the patient/employer has to take what the employer chose. No market for the patient.

Aren't healthcare costs in line with the very high US income levels (with people spending a high fraction of their income in it, because they can afford to), and the main issue is inequality (including lack of real insurance)?

We left the free market of healthcare behind because it was awful for consumers. People who were disabled or otherwise had chronic conditions were, more or less, completely screwed. Not to mention these regulations are very much necessary. We want educated and highly certified doctors cutting you up.