At the other end we have pure fee-for-service care with no guarantee of any care being provided for those unable to pay. Extra system efforts are not possible, as there is no system per se.
NEITHER of these extremes exists.
I am quite willing to stipulate that the USA's current system, the system prior to the ACA, and the system likely to result from the current Congress, are less then efficient. I am aware of numerous statistics that suggest US healthcare is less effective than that provided in other places -- at least by some measures. I even accept that some of this is certain to be true and that healthcare in the USA is imperfect (though I have always been frustrated by the lack of an 'apples to apples' style comparison (e.g. infant mortality before age 10. What constitutes mortality? Is a child who dies in the womb at 12 weeks counted or not? The counting systems are not always parallel).
If we fall behind in certain categories, how much of the shortfall is a product of cultural mores and behavior rather than medical efficacy?