They are the most expensive in the US system, possibly because they can be. US hospitals load costs artificially where they can (e.g. on the uninsured, because

They are the most expensive in the US system, possibly because they can be. US hospitals load costs artificially where they can (e.g. on the uninsured, because the insurance companies actually have bargaining power and wouldn't just pay any price). Outside the US, many of these aren't the most expensive ones. Furthermore, "multiple surgeries" and "multiple specialist visits" might be caused by an emergency, but are very rarely scheduled as an emergency - the first one, maybe; the rest usually have 48 hours to 14 days in between (which often cannot be shortened for medical reasons even if you wanted). The patient might not be able to comparison shop between while recovering, but their spouse/kids/parents likely could. Also, many of those emergencies cause weeks or months of hospitalization - but often moving to another hospital is medically reasonable, and if it cuts the cost of care down 50%, many people will prefer it over e.g. bankruptcy. The mere possibility that people will shop around tends to make a market much more fair. And additionally, on average emergency care, even if more expensive, is small in the grand scheme of things. Continuous treatments and medications, and pre-planned procedures are the majority of the overall costs.