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Short answer: they dont have single-payer
Longer answer: Its basically a big Ponzi scheme the government has allowed to spiral out-of-control. There are parasitic middlemen(HMOS) who cause the costs to rise significantly without adding anything to the final product. Also the doctor compensation costs have spiraled out of whack as people become docs as path to wealth rather than helping people. Also the billing process is unnecessarily complicated and retarded which also adds costs. To justify all of this the industry has tried to convince Murkans healthcare is a 'luxury' that only people with lavish incomes should be able to afford.
Longer answer: Its basically a big Ponzi scheme the government has allowed to spiral out-of-control. There are parasitic middlemen(HMOS) who cause the costs to rise significantly without adding anything to the final product. Also the doctor compensation costs have spiraled out of whack as people become docs as path to wealth rather than helping people. Also the billing process is unnecessarily complicated and retarded which also adds costs. To justify all of this the industry has tried to convince Murkans healthcare is a 'luxury' that only people with lavish incomes should be able to afford.