Again, drugs are a only a small part of overall health costs. They only make up 14% of healthcare spending[1] in the US. For contrast, they make up ~15% of healthcare spending in Canada, and ~16% of healthcare spending in the UK.

Your theory does not explain why the other 86% is so bloated.

[1] https://www.drugcostfacts.org/us-healthcare-spending

All my comments were deliberately couched to specifically not pretend there is a simple answer to healthcare cost bloat in the US. It is merely a testament to a single factor that increases costs while also inhibiting naive comparisons. The US healthcare system is awfully complex to even scratch the surface about causal factors in a forum post.

Beyond that, you may be conflating prescription costs with drug research, which is not the same. The fact that prescription costs take up roughly the same percentage of total healthcare costs seems to support my point. An equal percentage of a bigger pie would indicate they are inflated.

My personal stance is that the US optimized for access and quality at the expense of cost. As the saying goes, you can only have two. R&D spending is a large part of this. The US contributes over 40% of the worlds medical R&D, effectively subsidizing other nations. It’s not a bad thing and it doesn’t explain away all healthcare costs but it does create systemic ramifications. It’s been awhile since I’ve viewed the numbers, but the US had the highest health access and quality scores for a country of comparable size. Off the top of my head, I think the next closest was Russia. Again, the point being simple comparisons are harder than one may think when dealing with complex systems.

The only countries of comparable size to the United States are in the developing world. That's a horrible bar for the richest country in the world to be trying to meet. If anything, it has the unique advantage of having unprecedented economies of scale among developed nations.

I keep harping on drug prices, because you keep mentioning R&D. R&D is not the reason for why non-drug healthcare is so expensive. There is no mechanism by which high R&D costs lead to high specialist/GP/nursing/administration costs. There's no way for, say, Pfizer to siphon money from any of that into R&D. R&D is not the reason for why these costs are so high.

I’m only reiterating this because your responses make me think I’m not stating my central claim clearly enough: there is not “a reason” healthcare in the US is expensive. There are multiple, sometimes covariant reasons. Only one of those is drug prices. And if you don’t think pharmaceutical companies impact those other healthcare costs, you may not have a sound understanding of the healthcare system.

Related to your comment about the difficulties in comparison, you underscored my other point. People flippantly say “but look at country X’s costs” without understanding the nuances that make such comparisons worthless.