Looking at American policies from an outside perspective, it seems the government is unwilling to be the one that will actually suggest that maybe the answer to many current budget problems is to spend less.
The best most cost effective solution to health care is single payer government operation of the health care system. It's a tried and proven over decades to cut the cost of health care all over the rest of the industrialized world.
For some ludicrous reason, the beloved-by the British UK model of health care is called "communism" if it's even mentioned here
When did Great Britain turn communist? I completely missed that event.
But I don't think this is true of either the European socialist states, or of U.S. liberals. You can cherry pick examples of radical elements, Fox News style, but they aren't the main concern here - economic risk is the big one. A tightly integrated state can operate more efficiently than one that tries to regulate companies from afar, but if it goes down due to a "black swan" event, recovery is going to be more difficult.
Depends a bit on what you mean with efficency.
How many states have gone down? Somalia. That's it.
Now how many corporations have gone down leaving the people who the corporation agreed to provide services to in deep trouble?
It's almost quite literally infinitely more risky to trust a corporation than it is to trust government.