> It seems likely that you don't believe in the rights, the negative individual rights, that these Americans believe in
I’m probably also on the other side of this issue, but my take is a bit nuanced here. The government keeps the cost of healthcare high via a myriad of factors (long approval processes, requiring overtraining (years of calculus etc) for many tasks that don’t require it, having a certificate of need required to open a hospital, centrally planning the number of doctors via number of medicare funded residency slots, etc).
I think there is a moral case for a negative-rights oriented Milton Friedman style libertarian state that also addresses those issues (although even Friedman made a concession to utilitarian concerns with his negative income tax).
But there doesn’t seem to be a major US political faction making that case, or willing to spend the political capital or do the advocacy required to get there to any significant degree. Instead, the debate is mostly over the tax rates. I feel focusing primarily on the subsidies without the radical deregulation produces a system that is neither particularly libertarian or utilitarian, although it serves the interests of some fraction of voters.
> Modern history is full of movements promising utopias
You may be surprised but I agree pretty strongly here on the dangers of utopianism. I suspect where we differ is I view the movement to go back before the welfare state as in itself utopian. I think it is putting rose-colored glasses on the political economy of the industrial revolution, when that system fell to various forms of authoritarianism all over the world. In my view we would be better off with a political faction that accepted the fundamental logic of the welfare state while attempting to minimize the regulatory burden, although at this point it’s hard to see how we get there from here.