No, I think the part you miss is that some people succeeded at difficult reforms. Consider a reform where control of parts of each hospital's budget is removed

No, I think the part you miss is that some people succeeded at difficult reforms. Consider a reform where control of parts of each hospital's budget is removed from the owners/management of most hospitals. Might meet with some resistance, wouldn't you say so? You Americans seem to have this idea that your entrenched interests are somehow uniquely skilled at defending the status quo. Something like: "American hospital systems are so much better at defending their budget than that hospital system, so therefore that learning how that reform was executed would be pointless."