First, we do have government in mass transportation, because mass transit is a market that generally doesn't lend itself to free markets with competition well (multiple competing subway lines would be difficult to construct, for example). Second, the reason why we don't have or need government to provide clothing, food, or housing is that we have effective mechanisms by which to control the costs of those products. While each are needs, they naturally have competition. If I don't like the cost of clothing, I can go find a different company to provide me clothing. It is a market with high rates of natural competition and limited ability for a single company to decide whether or not I receive clothing. I also have acceptable outside options to the purchase of new clothing (e.g., keeping my current clothes or buying used clothes). In health care situations, the procedures and medications driving up costs are often those with limited outside options other than death. I can't buy a used heart surgery. I can't shop for other chemo drugs other than the ones only made by one firm that are just as effective at its primary functional value. The high fixed costs of operating a hospital mean that hospital systems, in local areas, are naturally going to consolidate. The same for many pharmaceutical products, where they are enforced monopolies for a given period of time and, under certain conditions, remain so due to the lack of a large market, even when they can charge millions to affected patients. Unless people become willing to die for financial reasons, or are willing to let their negotiating proxy credibly threaten that, they don't have the ability to lower the price on these sorts of procedures. The problem is that most people aren't okay with that and don't even view their insurance company as a negotiating proxy but rather an adversary that is trying to deny treatment.