Then compare, say, Massachusetts to high functioning north Europe systems. You will shrink the lifestyle and climate factors down to a pretty minuscule difference, but you will still find that the spending is dramatically higher.

You're not wrong at all that the US has some systematic issues that place additional strain on the healthcare system, but it's a "yes and" situation here. Even accounting for those, we spend far, far too much because our system is extractive.

You could maybe compare the Boston metro. It should resemble a European city with satellite villages connected by trains.

I would be curious as to the costs/benefits there.