This perception of the US as having a free-market economy, particularly in the area of healthcare, is curiously persistent.

Vast sums of money are spent lobbying to distort the market in favor of particular companies and industries. The FDA has long been accused of preventing key drugs from coming to market that are available in other countries. The patent system alone perpetuates medication monopolies over decades for fabricated reasons, keeping cheap generics out of people's hands. The tax system heavily favors employer-run plans (for reasons rooted in the WWII era) that encourage overspending, tie coverage to your employer, and distort the market in multiple, deep ways.

Medicare and Medicaid are huge. The chart in the FEE link below puts US gov per capita expenditures at 4th in the world.

The below Vox article, which is otherwise anti-free-market, concedes that generic insulin providers seem too daunted by secondary patents and "extreme regulatory complexity," both of which obviously run counter to a free market.

This isn't to say a free-market system would be a panacea of all complaints (systems dealing in scarce resources will never be perfect to all participants), but those complaints would be much different than those about the layers of bureaucracy, high government spending, low competition, high time-to-market for drugs, breathtaking lobbying efforts, and overwhelming tax complexity we have now.

Maybe you think you'd prefer single-payer to the present regime, but to characterize the latter as "free-market" sets up a false dichotomy. (Note that it could logically still be "underregulated," as you say, despite not being free - not that I would agree.)

Drug patents: https://www.statnews.com/2019/02/11/drug-patent-protection-o...

Tax distortion: https://www.forbes.com/sites/theapothecary/2017/07/30/why-ta...

Insulin prices: https://www.vox.com/2019/4/3/18293950/why-is-insulin-so-expe...

Free market? https://fee.org/articles/the-idea-that-the-us-has-a-free-mar...