Yeah, you’re right. I just don’t think perfection should be the enemy of good enough. Although, like others have said, Medicare and Medicaid are nowhere near even good enough. But they are programs that exists, and providers and insurers already have to, by law, negotiate with them. The laws need major reform, but it might be easier to make incremental changes rather than a total overhaul.
Plus the US does have many disparate laws guaranteeing some basic treatment. For example, hospitals have to provide stabilizing care for anyone, regardless of ability to pay. Incremental reform could gradually bring all those laws under Medicare/Medicaid, giving everyone time to adjust.