Most US spam calls originate outside of the US, though.
* Carrier maintainer blacklists and other tools have also been used by providers for a long time.
* My provider, Voip.ms, enforces a provenance whitelist by default. This block all SPIT calls coming from unspoofed caller ids. That may not sound like a lot, but yes, many of those calls are just random poeple picking their phone or mobile apps using the real phone number. Having regulation to track internal sources of SPIT (and enforcing it) helps too.
* In Canada, you can subscribe to a non-telemarketing list. That doesn't help for scammer, but it helps for unsolicited ads, political spam and private surveys. This works when enforced with actual penalties for all parties involved.