Why Are Americans So Filthy?

I.
Rebecca Schuman's review of the new German movie Wetlands contains the following quote:

The film is one that even the sexually laid-back Germans watch with half-covered eyes (“Nothing was spared,” said one of my German friends who’s seen it). So I’ll be interested to see how American audiences—stereotypically both prudish and hygiene-obsessed—receive it.

Reading this, I couldn't help but remember a passage from Jack Kerouac's Big Sur:

But Dave Wain that lean rangy red head Welchman with his penchant for going off in Willie to fish in the Rogue River up in Oregon where he knows an abandoned mining camp, or for blattin around the desert roads, for suddenly reappearing in town to get drunk, and a marvelous poet himself, has that certain something that young hip teenagers probably wanta imitate -- For one thing is one of the world's best talkers, and funny too -- As I'll show -- It was he and George Baso who hit on the fantastically simple truth that everybody in America was walking around with a dirty behind, but everybody, because the ancient ritual of washing with water after the toilet had not occurred in all the modern antisepticism -- Says Dave "People in America have all these racks of dry-cleaned clothes like you say on their trips, they spatter Eau de Cologne all over themselves, they wear Ban and Aid or whatever it is under their armpits, they get aghast to see a spot on a shirt or a dress, they probably change underwear and socks maybe even twice a day, they go around all puffed up and insolent thinking themselves the cleanest people on earth and they're walkin around with dirty azzoles -- Isnt that amazing? 

give me a little nip on that tit" he says reaching for my drink so I order two more, I've been engrossed, Dave can order all the drinks he wants anytime, "The President of the United States, the big ministers of state, the great bishops and shmishops and big shots everywhere, down to the lowest factory worker with all his fierce pride, movie stars, executives and great engineers and presidents of law firms and advertising firms with silk shirts and neckties and great expensive traveling cases in which they place these various expensive English imported hair brushes and shaving gear and pomades and perfumes are all walking around with dirty azzoles! All you gotta do is simply wash yourself with soap and water! it hasnt occurred to anybody in America at all! it's one of the funniest things I've ever heard of! dont you think it's marvelous that we're being called filthy unwashed beatniks but we're the only ones walkin around with clean azzoles? " -- The whole azzole shot in fact had spread swiftly and everybody I knew and Dave knew from coast to coast had embarked on this great crusade which I must say is a good one -- In fact in Big Sur I'd instituted a shelf in Monsanto's outhouse where the soap must be kept and everyone had to bring a can of water there on each trip -- Monsanto hadn't heard about it yet, "Do you realize that until we tell poor Lorenzo Monsanto the famous writer that he is walking around with a dirty azzole he will be doing just that? " -- "Let's go tell him right now! " -- "Why of course if we wait another minute

    ... and besides do you know what it does to people to walk around with a dirty azzole? it leaves a great yawning guilt that they cant understand all day, they go to work all cleaned up in the morning and you can smell all that freshly laundered clothes and Eau de Cologne in the commute train yet there's something gnawing at them, something's wrong, they know something's wrong they don't know just what! "

 II.
Now, I was born and raised here in America, so I can sympathize with my shocked American readers who shift a little bit in their (now filthy) seats at the prospect of washing yourself after using the toilet. But one day while we were dating, my wife - who is from Bangladesh - gently suggested that the next time I use the toilet, I ought to wash myself with the little pot she kept in the bathroom specifically for that purpose.

The suggestion was mildly embarrassing, but it only took one experience to learn that using the pot is much more hygienic than not using it. When I visited Bangladesh, I discovered that there they use a separate hose and spigot. Using the hose and spigot is more hygienic than using the pot

Of course, as my income has risen over time and I've had the opportunity to do even more world travelling, I have been exposed to facilities that included a separate bidet. This is the most hygienic option of all.

A couple of months ago, I installed bidets in every bathroom in my household. If this sounds luxurious to you, you're wrong. The total cost was $60 USD. Each individual bidet unit was about twenty dollars and installed on my existing toilet in minutes, using only a wrench. My bathrooms are now the most hygienic bathrooms in the entire neighborhood.

Once you've come over to the clean side on this issue, if you're anything like me, then you start to get a little squeamish. I have to consciously put the matter out of my mind when I shake hands with people. I know they wash their hands, but their hands still get dirtier than they need to. And all it costs to prevent this from happening is $20-$40 and a little swallowed pride.

III.
My question is the same as that of Jack Kerouac's friend, Dave Wain. The United States of America is the largest economy in the world. We have some of the world's highest incomes, not by a little, but by leaps and bounds. Compared specifically to Bangladesh, we Americans live like kings. So, the question is why are bidets not installed in every bathroom in the entire country?

But if cultural biases prevent you from driving over to Home Depot to spend less on a device that will keep you clean than you likely spend on beer in a week, then I will make the question slightly weaker: Why are bidets not standard-equipment in every hospital in America? How about standard-issue for the staff bathrooms only? Why are our medical professionals walking around in a state of compromised hygienics?