And yet all Western countries - especially those with single-payer state managed care - provide better outcomes at lower cost to consumers.
Are you sure you're not confusing the US insurance system with an oligopoly?
Markets don't exist to magically generate low prices for consumers through competition, because businesses compete primarily for investor and shareholder cash, not to make end users happy.
The most reliable way to generate shareholder value is to create an oligopoly, and then squeeze consumers as hard as they can be squeezed - which is exactly why the US system regularly bankrupts participants, while regulated single-payer systems don't.