Plus a large portion of the public in America doesn't pay for healthcare directly (they either get employer-based health insurance or declare bankruptcy) so it

Plus a large portion of the public in America doesn't pay for healthcare directly (they either get employer-based health insurance or declare bankruptcy) so it distorts incentives while retaining the profit motive. Furthermore American society is seemingly setup to avoid exercise and healthy foods at any cost. The Japanese are just as wealthy, older, and they smoke more, but they have better health outcomes and they spend almost a third per capita on healthcare. Chile spends about a ninth on healthcare and their average life expectancy is a full year more than the USA. On top of all of this is the fact that people can get into debt at 1% interest. Hard to be cost-conscious when dear old gran needs a $20k (only $50 per month!) treatment to live another three months. Same thing happened to education.