Western European countries have been working these systems for over 70 years. It should not be that hard to pick and choose the best practices to design a USian system....except...the money, and the influence it buys.

Again, it's not hard to figure out what works. It's the price chart. Their costs are lower because everyone gets paid less to provide medical services.

There's rent-seeking in our system, but it's not anything close to large enough to explain away the discrepancy. Medical school costs? We graduate about 20K new doctors a year, which even at $500K a pop for med school (which is too high) is "only" $10 billion per year - a rounding error in medical expenditures. Take the largest health insurance providers and look at their total profit in a year, and it's "only" around $25-30 billion for the lot. Again, a rounding error, less than a point of health care costs. The delta on Medicare Advantage vs. regular Medicare (another bugaboo) is about $80 billion. Now we're getting into a little bit more real money, but in a world where total U.S. health care spending is $4.9 trillion, it's still a drop in the bucket towards getting us closer to other countries.

In order to pay less for health care, you have to pay less for health care. Fewer nice buildings, fewer single rooms, less slack capacity, more waiting and queueing for services, and lower compensation for providers - and not just those nasty drug companies.

web.archive.org - Physician earnings worldwide
statista.com - Average salaries of nurses in selected oecd countries).

To borrow a phrase, you can't cut the health care budget simply by targeting "waste, fraud and abuse." You have to actually make voters you care about worse off. Which is why it doesn't happen.