There are definitely things in the system that drive prices up (like lack of competition (see CON) and middle men). However, a big reason you see this high cost and difference between countries is Baumol cost disease. Productivity and salaries in the US are very high. Meanwhile healthcare, like education for example, has seen very low productivity improvements. This leads to an ever increasing price. It's unintuitive because the healthcare workers didn't get more productive. However, they could be more productive elsewhere, so comp needs to go up to stay competitive with other options available to the workers. One might argue that nurses for example still earn very little, given how hard and important their work is but that's precisely what you'd see in areas affected by Baumol. The comp only gets dragged up to keep people from quitting or striking. There is little to no competition for something like a "10x nurse" because that's not a thing and the industry struggles to keep justifying their high prices while TV prices keep dropping and dropping and cellphones keep getting more impressive.