This is one of the key factors: access. We can cut costs but that generally means removing access for a lot of people. There is a cost for having an UrgentCare and a CVS on every corner. This also means driving larger distances to get care which Europe doesn't have at the same scale given their density.Removing all that cost also means removing 100Ks of jobs (some direct, some indirect because even grocery stores make a killing on prescriptions). No one is going to vote for that. Instead we'll keep doing what we do with everything else, raise taxes on the middle class to pay for everyone else.

We also need a better way to separate emergency healthcare insurance (which is what we have for cars) from regular routine things that should maybe be paid out of pocket or socialized. We also need to cut down on the abuse and that is what you are talking about. No ER for a cold and less unnecessary tests and cut back on cancer treatments for people over 80 (most everyone is at risk for cancer eventually, this is just a result of aging, not an unfortunate event for a 20 year old).