The US's non-paying contingent doesn't need to be any different from any other countries in order to cause the problem. The issue is that the uninsured subsidize the non-payers alone. This is radically different from countries with universal health care where the costs are spread among the entire tax-paying population.

As for why the US spends more than any other country: it's due to an overabundance of caution among the comfortably insured. It's much easier to get a variety of expensive (and often unnecessary) tests and scans (such as MRI scans) in the US. In countries with universal health care these tests and scans are restricted only to those with demonstrable need and they may be subject to long waiting lists.

> As for why the US spends more than any other country: it's due to an overabundance of caution among the comfortably insured. It's much easier to get a variety of expensive (and often unnecessary) tests and scans (such as MRI scans) in the US.

Countries with universal healthcare also tend to have private health companies which can provide tests and scans at a higher speed, either on an insured or a pay-as-you use basis, typically at much lower costs than the US. Yet there doesn't seem to be the same "overabundance of caution" elsewhere. To the extent that precautionary procedures are responsible for high US spend, I don't think that can be decoupled from a system designed to ensure that primary healthcare providers are sales outlets for those procedures.

Do you have numbers for that? Even the comfortably insured in the US have to pay a fee when they visit a doctor, typically around $35 for GP and $100 or more for a specialist.

My last 5 insurers had copays between $0 and $20. Same price whether it's a specialist or primary care.

If it's an HMO, often it's just free entirely. PPO plans tend to have a small fee -- it's never been enough that I've given it a second thought -- and have wide coverage with few limits.

My wife and I never pay a fee to see our doctors. I pay $30 for sick visits for my kids. $100 seems really high. I’ve only had something like that for a test.

Imaging is used as a revenue center. Many states restrict CT and MRI machines based on the broken thought process that restricting capital spending will lead to lower overall prices. Of course in reality you also restrict investment and competition.

The out of pocket costs are high here because of an $8k deductible, it is a choice.

The issue is why it costs $6.5K to get the stitches rather than who pays for it.

I mean, it's clear that it's not sustainable to have a healthcare system in which stitches cost this much. Things are not made any better or less outrageous if these costs are transferred to someone else or if they are paid out of pocket.