Maybe there are too many bureaucrats that all the expenses are bloated and funding payroll of unproductive gov workers.

Personally ive found that to be more true in most countries.

Civil service/Gov workers get tons of new unnecessary roles with bloated titles for departments that barely do anything, just to maintain a cycle of promotion, to keep the gov workforce “motivated”.

Not that i disagree that United Health is price gouging that there are way too many corrupt unnatural monopolistic companies preventing america from growing fast and allowing innovation to take place.

I think both things are true at the same time.

Talk to any gov department and they’ll often tell you, the budgeting is structured in a horrible way that it encourages them to do wasteful spending, they must keep spending entirety of their “budget” to retain a similar sized budget next year, “use it or lose it”, to avoid going through hassle of convincing politicians to re-boost budget later, departments resort to wasting money with meaningless expenses just to retain their budgets…

Extrapolate that to a gov that spends more than a trillion dollars annually at times and this is a disastrous level of wasteful spending.

In my country, you wouldn’t need an in person ‘appointment’ to merely change an address on a driving license.

Seems rather inefficient to have offices all over the state, appointments, inefficiencies like missed appointments, and the waste of citizens’ time, for a process that can be done by mail.

Moving states requires validating the information from the previous state too. It's not a matter of the new state just updating an entry in its database. It's an entirely new entry. Given that, in person validation makes sense.

Moving within a state is simpler, and indeed can be done online in most states.

Granted in many countries there's a national ID system. Also a part of the point of government-issued IDs is that there's more validation around its issuance, and many other parts of society take advantage of that.