US private healthcare as it now exists is extraordinarily wasteful and expensive, and the cost to business, which is forced to pay for it, has gone up far beyond the rate of inflation over the years. It is a huge and growing burden, which the existence of the NHS (which is the next best thing to individual payer healthcare in how it operates) frees British business from.
Even on a purely practical level, US healthcare doesn't have much going for it. Essentially, provision of US private healthcare as part of a compensation package constitutes a healthcare tax for most employees. Depending on family size and the sort of package a company can afford, an employee can see anywhere from 1K to 10K per year find its way to the coffers of an insurance company. This is on top of federal and state taxes that pay for local healthcare provision for the legions of people whose jobs come without insurance or without the sort of insurance necessary to cover items such as maternity care or vaccinations for your child (that can cost hundreds of dollars each and are required for school admission). Even with group health insurance that is provided out of your salary and acquired by an employer many find a high deductible or exceeding the lifetime amount available for, say, cancer treatment, will force them into bankruptcy. Many put off seeking treatment for mental illness until it becomes absolutely necessary because future coverage can be denied due to existing conditions. Americans are overtested and medicine is mechanised and geared far too much towards the cure of symptoms instead of the prevention of chronic illness that constitutes the biggest claim on insurance companies.
Anyone who thinks there is merit in a system that forces people to put off going to the doctor for fear of the bills, one that forces the elderly to cut pills in half and hope for the best, or choose between medicine and food, and scorns the benefits of a 'free at point of service' system does so for reasons of pure begrudgery towards the poor, and anyone who thinks the US has a superior system after looking at infant mortality figures there is in fact right wing and lacking in compassion. Your 'give me U.S private care any day rather than the NHS' is an example of very muddled thinking about the NHS, its aims and the ideal it embodies, and misguided notions about what US healthcare provides for the extraordinary amount it costs. The price of everything and the value of nothing...
You can't brush away the ugly fact that in the US, halfway adequate healthcare is only available, at a price, to those who can afford it. It is a commodity. The philosophical implications of that are cold and lacking in compassion. British society has arrived after hundreds of years of grinding poverty and deprivation for the majority at a much more civilised notion of what we owe each other in terms of support. When healthcare becomes an industry run on a profit model rather than a service designed to treat the sick and prevent suffering or death, sick people lose, and the sick poor lose most.
There is no such thing as wonderful healthcare that is free or low cost, anywhere. Someone has to pay. Whether the payment comes from a salary before tax or as a form of income tax, that 'someone' is the consumer. Far better imo to have a system based on the consensus that access to healthcare is an entitlement that comes with citizenship, a good thing for everyone, and the responsibility of all to pay for it. Better for the babies of the poor and that's for sure, and for the old. You don't have to be grateful for it on your own behalf, but not seeing the benefits for others is the opposite of compassion. I suppose it really does boil down to your value system, as you point out wrt your friends and where they choose to put their money.
Echo chamber politics is a phrase used to describe preaching to the choir, and has nothing to do with reaching out to undecided voters. The US has a huge rate of voter apathy. Election turnout tends to be extremely low. Keeping the zeal of the faithful fired up with appeals to their prejudices is a completely irrational strategy for anyone interested in attracting more support for a position they hold. It works fine in a society where the majority of citizens shrugs and finds something else to do on election day.
Apart from the rhetoric on the right of the Republican party, American public policy and debate has a largely consensual foundation. The Democrats and the Tories have much in common, with the Republicans providing the loudest and most active loony fringe. There is not much to choose between a moderate Democrat and a moderate Republican. The one lightning rod issue that has constituted the only real political divide for decades is that of abortion.
In all other areas there is basically the same amount of consensus as in Britain, but in the US the basic assumptions are far more conservative than in Britain. The word 'socialism' strikes fear equally in both parties (but a Republican is more likely to shoot you over the question...) However, unlike Britain, there is no motivation to appear willing to compromise or work together with the other party, and in fact a great fear of it. To do so would be to risk political suicide, with the likes of Rush Limbaugh on right wing radio ready to pounce and question your orthodoxy if you put a foot wrong. The faithful don't want to listen to prophets who tell them things they've been told by the radio charlatans they don't want to hear. A small, elite group of loudmouths with microphones essentially is trying to dictate policy to the Republican party (Beck, Savage, Limbaugh, O'Reilly, et al) and bang the Tea Party drum.
As for elites deciding public policy in general, with media firmly in the hands of business conglomerates, who now have the right of free speech on a par with individual citizens' rights in the political arena, and the graduates of a small number of universities cropping up time and time again in the upper echelons of administration, law and business, and in the political arena, it would be hard to escape the impression that the 5% doesn't have much more than its fair share of influence in the US.
As for patronage and politics and the cosy relationships between politicians and business even in a system where Big Gummint is anathema and the free market is worshiped by all read 'Boss' by Mike Royko, about Chicago politics and corruption, and look at the recent trial of Rod Blagojevich (sp?), former governor of Illinois, or the career of Ed Vrdolyak yes, I have spelled that one right. Three former governors of Illinois have done time for racketeering and/or corruption.
If people didn't want to watch BBC then they would not watch it, or any other terrestrial commercial channels for that matter. And in fact, viewership has dropped overall for all channels with the rise of digital media. People still like sports, drama, soaps, and value the news and current affairs programming the BBC provides alongside the commercial channels -- who provide much the same fare and who are all obliged to provide religious content such as Songs of Praise that are not popular. My reference to 'lowest common denominator' was a comparison of BBC output with the sort of disheartening dreck, (market-driven, advertising and merchandising vehicles) available on a lot of cable channels and even broadcast channels in the US. Anyone who has ever sat through a programme such as Hannah Montana would ask anxiously if there was more where that came from , and the answer is yes, sadly, there is lots more.
It is worth noting that all terrestrial channels are obliged to provide a certain balance of public service broadcasting. All channels take note of what the viewing public wants -- campaigns about the portrayal of LGBT individuals will hopefully result in the end of the caricaturing of gay characters as camp; the portrayal of racial and ethnic minorities is a far cry from how it was back in the 70s (remember 'The Black and White Minstrel Show'?) Ofcom takes into account market needs, technology, and viewer taste in attempting to determine the roles of various media in the UK, with its purpose based on the underlying assumption that a variety of views and a variety of programming is good for society. There is a version of Ofcom in the US, whose role is concerned mostly with antitrust issues and the upholding of some sort of 'public morality', the prevention of wardrobe malfunctions, etc. No surprise that money and prudery issues govern the airwaves in the US whereas social responsibility and nurture of the body politic tend to dominate the debates on programming in Britain.