" Ours is a bureaucratic mess with a zillion little pieces..."
... because of how progressives like you have been undermining it for the past 70 years, preparing for the final takeover.
The vast majority of medical research breakthroughs occur in the United States because of what remains of free enterprise here. That will soon come to an end. Until recently, people sent their most serious patients here to be treated, because our recovery rates were far better than anywhere else. That will soon end, too.
And if you guys hadn't been hammering for decades, our system would be far better than theirs in all other regards as well.