It's a combination of many different factors that all add up. Off the top of my head: - End of life care in the US is indeed a lot more extensive than in othe

It's a combination of many different factors that all add up. Off the top of my head: - End of life care in the US is indeed a lot more extensive than in other countries. - As davidw said, administrative overhead throughout healthcare is ridiculously inflated due to the nature of having to deal with insurance companies and billing. This is both people and software. - Drugs generally cost a lot more than they do elsewhere in the world due to a lack of regulation on costs and the need of pharmaceutical companies to recoup their development costs by charging Americans more than they can make elsewhere. - Without a single payer system, billing is completely ridiculous and leads to hospitals way overcharging for services, knowing that insurance companies will negotiate it back down. - Hospitals are required by law to treat everyone, even uninsured and homeless people who will never be able to pay for their care, so they have to charge more to everyone else to compensate. - The profession of doctor in the US is a weird semi-monopoly setup with artificial constraints on how many new doctors enter the market each year. As a result, you end up with people spending a good chunk of their lives studying to be a doctor, regardless of what kind, and taking on huge debt until they become a "real" doctor. The end result is that the profession makes a lot more money than it does in other countries. - Because healthcare in the US is so expensive even with insurance (the amount you have to pay before your insurance kicks in can easily be thousands of dollars a year), many Americans don't use healthcare for preventive care and thus health issues that would be cheap to prevent become expensive to treat later. - Hospitals in the US are mostly private and for-profit, with margins in the 6-8% range. That's money going to executives and shareholders rather than to actual healthcare.