Keep in mind that not only insurance is a factor, but also the fact that many hospital systems themselves are private and have lots of cost pressures. A fair amount of advertising I've seen is for hospital systems.
Also, most hospitals in the US are nonprofits, though that doesn't free them from cost pressures or the need to advertise.
America's fear of regulation results in more workers being injured and developing chronic pain.
America's broken healthcare system means that people are less likely to have access to alternatives such as physical therapy, meditation, counseling, etc.
America's weak social safety net means that people have to relieve their pain so that they can continue working.
Cultural factors result in people being less accepting of pain as part of their lives.
My mom ran different units in busy NYC hospitals in the 80s. At that time, the protocols for most pain events were Tylenol and/or Motrin. Getting more than 600mg of Motrin was unusual.
When I had back problems in the early 2000s, the protocols were totally different. If you had back pain, once the newer NSAIDS like Vioxx and Celebrex were mostly removed from the market, the substitute was an opioid. In my case, physical therapy, motrin/aleve, etc helped until surgery was required. I know a few people who went to opioid route, and a couple of them have struggled with dependency.
It must be that elsewhere doctors more frequently say “yes, your condition is painful, but if normal painkillers don’t help, the next alternative is worse than the pain”.
It’s not clear to me why this discrepancy exists. Pharma can’t be the only reason. Maybe the private insurance system is a factor (“I paid a lot for this healthcare now fix my pain or I’ll take my business elsewhere”)?