Complaining about the service quality for public health insurance customers in Germany is pretty much the definition of "first world problem" though. FWIW I never switched over to private insurance even though my income would allow it, also once you get above a certain age you can't switch back and that's when the private insurers really start to rip you off ;)

And despite that they are willing to pay, because if you are out of poverty your health is a high priority!

So yes, Americans love consuming healthcare. Is there any category they aren’t a high consumer of? You can’t measure efficiency only looking at the input side.