Comment by estearum

I would suggest it's the reverse. Americans accept higher prices because they have many many layers of intermediation.

Americans pick their employer. Their employer picks their health plan. Their health plan picks which drugs are covered and which doctors and pharmacies they can use.

With the "innovation" of vertical integration between insurers, healthcare providers, and PBMs, there is effectively zero incentive for health insurers to manage costs, because those costs show up as revenue for their own subsidiaries. This is actually hugely advantageous for insurers because they are required by law to spend a certain percentage (~80%) of their members' premiums on healthcare goods and services, not profit or business development.

Well... if you own the pharmacies, the PBMs, the GPOs, and especially the healthcare providers... you can arbitrarily siphon money at any % rate you want while increasing the gross dollar intake by simply raising prices at your subsidiary companies!

All of this is well documented. Here are a few places to start:

https://www.statnews.com/unitedhealth-group-investigation-he...

https://hntrbrk.com/pbmgpo/

https://www.wsj.com/health/healthcare/unitedhealth-medicare-...