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Well, I will say that of course the healthcare system can be improved. I will also say that we don't have the 42 best system... I have no idea how something like that would be measured in any meaningful way. It is very easy to cherry pick or manipulate statistics to basically create any outcome you want (like when people used to say that Cuba had the "best" system. Of course this is complete BS). Also, remember that other systems would not be able to perform the way they do without the US direct and indirect subsidies to those economies.
American healthcare is expensive for many reasons:
-we have the most expensive personnel in the world (this is also a major reason the US military budget is so much higher than everyone elses)
-we subsidize innovation for the rest of the world, pay the development costs and provide the markets that stimulate medical advances
-regulations force construction costs and "medical grade" equipment costs to he very high
-educational costs for personnel are astronomical, and overly long
-a typical cultural phenomenon in the US is to "full court press" all patients, including the very frail premature babies and the very old and frail vs other countries that expend less resources on those populations
-as a very rich country, we have the resources to spend more on healthcare, just like we spend more on everything else (luxary goods, entertainment, recreation) than other countries that are less wealthy