1) Governments are chock full of people who have the right motives, and thoughtful policy-development smarts, but insufficient knowledge of the operational aspects. Everyone would agree with what they want, but they just don’t know enough about the details of how things work. This is true at all government levels in all jurisdictions. Is it avoidable? I doubt it. After all, we vote for people who tell us where they stand on issues of importance. We vote for their values and priorities, and we don’t vote for their knowledge about the details of project management, since they usually have people to do that for them. Ironically, we can end up despising them for their values, when the real problem was that they didn’t know enough about how to implement them.
2) Once a system is deeply entrenched, it becomes VERY hard to revise it, and its tentacles find a way of being woven into more than you’d think of. For example, with provision of health insurance by employers, rather than the state (as it is in some other countries), American employers have been able to successfully argue in the courts for maintaining “snitch lines” to report employees who smoke. Not smoke in the workplace, but anywhere. The rationale is that the increment to employer premium rates, if they had known smokers on staff, would constitute an undue hardship for the employer. This sort of interweaving of health care and employment law strikes those in other nations as an oddity. I mention it not to rail about it, but to illustrate how a system can become so deeply entrenched that one doesn’t even notice when it extends well beyond the perimeter of what the system is supposed to be addressing.
3) That something is entrenched and hard to change is insufficient rationale for why it should NOT be altered. At one time, slavery was also deeply entrenched in society, and difficult/painful to modify/remove. But here I go back to point #1: having the right priorities is not the same as knowing how to smoothly move an initiative through its various stages to successful and sustainable implementation.
4) A nation whose citizenry is not healthy is unlikely to be particularly competitive.
5) Americans have known for decades that there needed to be a better way. If I recall correctly, one of Pres. Clinton’s platform planks was revision of health care. It was NOT something he invented out of thin air. It was a response to an ongoing perception that preceded him. But, those changes didn’t happen for a variety of reasons, and in the interim, point #2 above dug in deeper and deeper.