Hi dig,
The US has form with difficult questions.
The change-obstructing constitutional philosophy tends to generate tensions which finally snap.
One of the main arguments of this board over the years has been between on the one hand, the idea of the protections against bad policy afforded by a Burkean conservative ideal, and on the other, the idea that policy needs to keep up with the demands of a changing society and environment, which means the acceptance that initiatives will sometimes head off in wrong directions.
I see healthcare as an example of a feature that needs fixing (increasing costs of insurance as a percentage of GDP being a major issue). But the difficulty of even trying a fairly humble experiment is so great that one wonders quite what it would take to affect major change.
Is it fair to observe that the US seems to make its major changes in the aftermath of major catastrophes? It seems unable to do gradualism at a rate which might avoid having the small problems become big ones.