> This is what the free market fundamentalists wont accept: that their precious private enterprise is often terribly bloated and inefficient.

> The most free market oriented I’ve experienced was the American one and it was by far the most bureaucratic.

Private enterprise? Free market? You seem to either misunderstand these terms or make incorrect assumptions about the workings of healthcare in the United States.

A necessary component of any free market is open price signals which communicate information to all parties of a transaction, before the transaction takes place (e.g. a forest fire reduces the supply of trees; lumber companies charge paper companies more; the price of paper goes up in turn; I buy less paper because it is more expensive, and no regulatory czar needed to adjust his schemes and standards in light of the forest fire for me to know to buy less paper... I didn't even need to know about the fire to have actionable information about its consequences). Prices communicate more information with greater efficiency than is possible with central planning because they communicate information without an administrative overhead.

But the US 'market' for healthcare deliberately obscures price signals for the actual goods and services involved in each transaction. How many Americans know, upon receiving a prescription, what the listed medicine will cost? How many know the costs of each medical test recommended by a doctor? This opaqueness is a result of rent seeking by some parties to the transactions. (How many know about the kickbacks their doctors receive from pharmaceutical companies for recommending medicines and tests?) Yes, these rent seeking parties are usually corporations of one kind or other, but their business is so intertwined with and dependent upon the state, its powers, and its whims that these corporations cannot reasonably be called 'private enterprises' anymore, if they ever could have been.

The US market for healthcare is not a free market.

It is a highly regulated (as in controlled) and opaque market with no downward pressure on price from consumers because no price is visible until after the transaction is complete. That state of affairs is plainly absurd (and not at all apparent) to anyone not from the US. But it's also not a free market, either as casually or formally understood.

> That is essentially the function of government. It is what creates the common interfaces.

Disagree strongly here. People create common interfaces because they are useful, then the government codifies and calcifies those interfaces and standards (which does have some utility on a case-by-case basis). PDF is not a government-created standard. Though international and governmental bodies have standardized it after the fact, it was created by a private company and even before the format's standardization you could view a PDF on just about any computer. Linux was not created by the conscious effort of any state, but it runs on myriad hardware and is used by the majority of web servers. Even POSIX and other engineering and scientific standards are usually agreed upon by private (as in non-governmental) professional associations before the state becomes actively involved, if it does so at all.

The function of government is to institutionalize the use of force in society, recognizing that force of some kind will always exist and it should be limited in some way (unless you disagree with the latter two propositions, in which case you might be a philosophical anarchist).

> That is what I notice most about the US. There are so often no standards for anything. People just wait for the magic of the market to create one, except that never happens and you end up with half a dozen competing and incompatible standards.

Can you give examples?

I grew up in America, have lived elsewhere, and 'no standards for anything' isn't part of my experience, either as an American or in comparison to other places I have lived. I would argue that maybe Americans don't wait for the magic of the state to create standards, and set about the business of creating standards and doing work for themselves. Sure, you sometimes have competing standards, but I don't see how that's a problem. A better, more robust, more useful standard is likelier emerge from that competition in-the-field than it is to emerge from the diktats and musings of bureaucrats in-their-towers.