It's worth noting that the index there accounts for "business freedom" and "labor freedom" but doesn't really account for what is on topic here: "startup freedom".
Occupational licensing has some overlap, but regulations are often very good for very big businesses since they impede competition from small challengers. Anyway, I'm mostly sympathetic to your points, but it's important to distinguish between being 'business friendly' and being 'friendly to status quo corporations'.
Because the complaint there is closer to "wow, we're paying the most and we're not even close to the top" rather than saying the quality of care is objectively bad.
How much separates them? Other than NZ which tries hard to bring investment. I don't think there is significant daylight between those at the top. And I don't think it's a good idea to relax the rules in this area of commerce.