small businesses would benefit, and entrepreneurs,
Quite possible. Rates of self-employment are higher in France and Germany (2022 OECD stats). I’m not sure if that figure should be taken at face value, though.
unless it was a Germany style system
You mean a system with mandatory insurance? Administrative costs are substantially higher in US health care. Anything to bring quality and costs more in line with peer countries would mean a substantial hit, regardless of the system adopted.
Why not pay people to do something with a good impact on the land or the people?
Good question. Just a cursory glance into the statistics will tell anyone that the US system is dysfunctional. It’s been that way for decades or longer. I don’t even know when it became obvious that it wasn’t doing as well as its peers. And yet, there hasn’t been a lot of effort to improve it (Kudos to Obama, though). Maybe Americans just don’t want to do what it takes. Maybe they just want a better outcome, without all the small, necessary steps to get there.