A few things.

-The US has had a lot of success by letting businesses run pretty free. This has produced some of the largest and most powerful companies on the planet.

-The conservative party traditionally has been suspicious of a powerful, centralized government

-In the US, there is a common thread of "government workers are impossible to fire" as well as a common thread of "government moves at a snail's pace".

In light of just that, there are many people who would prefer that healthcare is run by a private industry, as private insurers are enormous companies in the US. Everyone knows Blue Cross Blue Shield, Aetna, or Kaiser Permanente. Many people give a benefit of the doubt that companies are doing things efficiently. Additionally, health insurance companies in the US have a requirement to spend a certain % of their revenue each year on medical care, and will sometimes send out small refunds when they simply cannot suppress costs in certain other regions of the company enough to keep their spending at the right rates.

Beyond this, states may provide additional benefits, and many do (some with the help of federal funding, even). You may find someone in one state where they are suffering greatly, while someone in an identical economic situation in another state is not suffering at all. It's easy to convince the first man to vote for a better healthcare situation. It's hard to convince the latter.

I could go on for ages, but this is getting long. There are like a billion reasons.

The people who vote are old. The median age of primary voters is 65, regular voters 54. This is why you get a gerontocracy - old people vote for their interests, and young people don't vote. It's also probably why the median age of politicians has risen to 58 and 66 in the house and senate, respectively. With an 80-year-old president.

The solution is to have both a) mandatory voting and b) a voting holiday. This is done in many other democracies around the world, and it works. Personally I would prefer term limits and age limits for congress, the president, and federal judges. Diane Feinstein, Ruth Bater Ginsberg died in office. Mitch McConnell is working on it. We have age limits for lots of professions that require high performance - political leadership should not be an exception. But of course to make any of these changes young people have to vote, but they're mostly busy being poor and doomscrolling to block out the pain.

- Dogma - us vs them mentality - we’re not that smart

Stupidity https://youtu.be/HbQ-t8GXYTA