Many would argue that this very clearly shows the US gov is unable to provide cost effective healthcare, if they’re already paying through the nose and not even covering the entire population how would adding a single payer system be more efficient?
because if you are the single payer (govt), you can negotiate much much better rates.
Unless of course you are barred by law from negotiating rates.
Laws that you, the govt, make?
Yes. There are different levels of governments and those can be at odds (witness: laws limiting or barring municipal internet).
And there are people who specifically aim to be elected to kneecap government services.