The structure is a messed up mix of the red tape and regulation of a government bureaucracy, monopolistic behaviour (try getting 3 quotes for a procedure like y

The structure is a messed up mix of the red tape and regulation of a government bureaucracy, monopolistic behaviour (try getting 3 quotes for a procedure like you would for a bathroom renovation), subsidies, freeloaders, and weird incentives. The government has decided it's too stupid to run hospitals. But it's also decided that it needs to ensure both the supply of hospitals, and to maintain standards. So instead of just telling doctors what to do (and paying them enough to ensure a steady stream of high quality medical students) it tries to get all the red tape and subsidies right, while the private sector (hospitals and insurers) try to figure out how to outsmart the government and make the system more expensive. The US government spends a similar amount (per captia or as a percent of GDP) as Canada on its public funding (Medicare, Medicaid, VA, and so on). But the US system is so fantastically inefficient (due to weird incentives and massive amounts of bureaucracy and profit seeking) that unlike Canada it can't even offer basic universal healthcare (despite spending an insane amount of tax dollars).