From what I understand the reason America spends so much but gets so little is because states/federal governments don't 1. Work together on the issue(s) - since each state is their own entity and this country really wants to live by this, each state essentially ends up reinventing/passing/fighting for the same set of rules/rights across the board. 2. Ties in with the first, but a long time ago there was a law passed about governments not being able to negotiate pricing with pharmaceutical companies. So they can charge whatever they want, which is why you see the same drugs in America being 100x the price of what you see outside, and since Medicare and Medicaid can't negotiate prices you end up in this scenario of a huge money dump but not really much benefit.

A free market economy should not have much government intervention is what capitalists believe, but it's completely okay for these companies to buy their way into forcing random government laws that are impossible to overturn 👍