Sure, it's similar (no coincidence, as you point out). Most people in the US don't directly participate in the ACA marketplace. For all the talk about freedom o

Sure, it's similar (no coincidence, as you point out). Most people in the US don't directly participate in the ACA marketplace. For all the talk about freedom of choice, i'd venture that the majority of Americans have no real choice in what insurance they'll get (apart from their freedom to switch jobs or pay a higher price on the exchange by forfeiting their employer's contribution). We also have a significant population (~15%) on a public system that has an influence on prices that everyone pays but no authority to negotiate drug prices. I don't think that any one of these differences is an explanation for the gap between ~11% of GDP and ~17% but there are enough of them that it's hard for me to decide public vs private is orthogonal.