Middle men in processes add overhead, but on various analyses I've seen.. zeroing all middleman (insurance, PBM, etc) out still leaves us as far more expensive than the rest of the rich world.
One thing which is not terribly popular to point out is that at least on procedure pricing - wages are way way higher here. Some of that is that education is far more expensive so then we need to pay very well to pay that down. Also we have a cartel that limits the number of medical graduates.
NYC have been striking and to quote the union-friendly NYT "The three hospital systems affected by the strike said their nurses on average make about $160,000 a year and are seeking raises that could propel nurses’ salaries on average past $200,000, according to the hospitals."
By comparison UK pays nurses like US blue state fast food workers. Per google - "Average nurse salaries in London are the highest in the UK, generally ranging from £37,000 to £55,000 per year." Note NYC minimum wage is at $17/hr though many hospitality workers in the $20s, with a renewed Mamdani push to $30/hr minimum.
And US tax rates at these 3-4x higher compensation levels are same/lower than the UK..
Then add Americans having generally unhealthier lifestyles, being more litigious requiring higher malpractice insurance, etc..
Why are we attacking literal healers that want to be compensated fairly and have better standards for their patients?
The US is being pilfered by like less than 10,000 people so the federal government can give them corporate welfare worth $50 trillion over the decades [1] at the expense of workers.
But yeah... it's those damned nurses wanting to have fair wages and working hours that are the true enemy not the ghouls in SV that profit off of human misery... it's the nurses...
The idea that healthcare needs to be profit driven should be an idea excised from our collective intelligence.
[1] https://time.com/5888024/50-trillion-income-inequality-ameri...
Malpractice insurance is a big part of the higher salaries.