Dr dear Dr - Why do Americans run their hospitals like businesses, is there anything to learn from their commercial approach?

It might be something to do with the way that America is run, since America is not a democracy, repeat not a democracy, but is rather technically a Representative Republic. Most present day republicans are commerce-driven and so cannot fathom the notion of a universalist health care system. Still, there is some rumour around that America is changing, that an appetite for a monarchy-driven America might yet emerge, especially with the popularity among Americans of the young woke prince and his woke princess in California. There are several sources for an eventual monarchy over there in their DNA searches for the rightful heir to the American Throne, one might be Aztec for the successor to Montezuma, one might be a Red Indian one for the successor of Sitting Bull, one might be a representative one from the white settlers and colonials from the original governor of the settlement of Jamestown, one might be from the current variations of the political elites of the Clintons or the Trumps or the Bidens or Harrises, and one might be from the new races and ethnic groupings that have since flooded the country after the 1920s and 1930s. So all to be seen. Either way, it is always possible that in a monarchy-guided America, some provision might be made for a universalist theory of health care. The times, they are a changing.