[roc]

There's a very large amount of medicaid/medicare practice (and 'obamacare' practice) that was written by insurance and hospital lobbyists with a financial incentive to perpetuate the status quo, if not outright extend regulatory capture and stymie any actual market competition.

Given that something as simple as allowing Medicare to negotiate with care providers and suppliers as any other insurer is massively controversial, I think you would be amazed just how controversial seemingly-straightforward reforms actually are. Particularly those things that would increase competition and thus threaten the status quo.