You are not taking into account the number of people employed in the private health care system. Between insurance, pharmaceutical, hospital, clinic, lawyers(for malpractice lawsuits) advertisers(for everyone) tv(reliant on said advertisers) it's worth probably about 20+ percent of the GDP.
And you don't mess with that big a chunk without pushback. And a lot of people prepared to fight for the status quo because that's how they make their living.
I don't think it's insanity that prevents it. It's money.
Those wily Canucks began by co-opting all the private players into a scheme that ran under one big umbrella without really changing anything in the existing operation. Once they had everyone signed up — like making every car owner buy insurance, which was once thought impossibly idealistic — that made it attractive for employers to offer premiums as a pay-perk. Finally the law included those workers and the ever-shrinking group of direct payers in the taxbase as they convinced the insurance companies to step aside while OHIP and the other provincial agencies took over their workforce to do the same jobs as swivel servants.
Last I heard the Insurance companies were still profitable and doing quite well selling premium-paid extra benefit plans to employers and unions. And the med schools still have more applicants than they can handle.
The Republican work on the original ACA ensured it would be as awkward, cumbersome and unprofitable as possible, buyt some states still managed to make it work and keep insurance companies willingly involve. The post-Trump amendments put a stop to all of that.
The bottom line is American citizens who make the richest economy in the world are getting the worst health out comes at the highest cost, because they're being expertly fleeced by the best educated, most technically trained and complex establishment in the world (which is, needless to say, among the most expensive). And then there are the doctors and hospitals making themselves rich by making as few people as possible better.
And the Republicans first and only thoughts have been how to stop anyone form fixing any of that.
Give Trump credit, he saw through all that a long time ago. Like anyone with brains who wasn't chained to party, he saw and said single payer for all citizens is affordable best. But he needed a party to win, and hadn't the smarts, the will or both to bend the Party his way.
They bent him. But as a BigTent Party, they have so many unreconciled purposes and plans, the Party has achieved nothing useful except to make them and their President look like they don't know what they want, and haven't a clue how to get it.