Most Western health systems are universal and more or less exclusively government-funded. This means that the entire population is in the same risk pool, reducing costs for the more vulnerable users and increasing the incentives to implement more preventative medical practices. As de facto monopolies, these systems can do a much better job of controlling the costs of salaries, equipment, and drugs. And, because the systems don't need to turn a profit, they can operate at cost.

Our private health care system, however, has a cycle of perverse incentives -- employers, insurers, patients, and doctors -- that leads to spiraling costs with no increased benefits. The populations with the highest health risks (i.e. costs) are shoved onto the public rolls, in the form of Medicare, Medicaid, and the VA. Meanwhile, the lowest-risk populations are forced to pay into private, for-profit insurance schemes. Specialists have outsized bargaining power, which leads to grossly outsized salaries. Equipment and drug manufacturers can play hospitals and systems off of each other to bid up prices. And, of course, shareholders want a return on their investment.

This problem has everything to do with economic and tax policy in the US.