Research that I have seen largely suggests that health care is more expensive in the US compared to similar quality health care elsewhere. The primary cause, though not the only cause, for this cost imbalance is largely due to a variety of administrative inefficiencies that have grown out of balance over time. These inefficiencies are economically allowed to exist because many forms of health care are a basic need rather than a luxury want.

Some additional data from the insurance side of things is that about 5% of patients account for about 50% of health care expenses and about 1% of patients account for about 25% of expenses. This is not something to primarily solve for, but it is something the insurance industry must account for.

Solving even for the some of the most basic cost insecurities of health care is hard, because some side of the industry always benefits from a particular angle of each inefficiency. You have to be willing to financially harm a large segment of that industry to make it better for everybody else. Realizing this each segment of that industry (all industries) will maximize identity politics and team identity as necessary to ensure the survival of their collective business interests.