1. The US is huge. Good example that blew my mind: https://www.txmemes.com/post/texas-is-larger-than-any-european-country https://www.txmemes.com/post/texas-is

1. The US is huge. Good example that blew my mind: https://www.txmemes.com/post/texas-is-larger-than-any-european-country https://www.txmemes.com/post/texas-is-larger-than-any-europe... 2. Economic variables can vary significantly between regions 3. There are artificial barriers that significantly distort the market for health care - the most egregious being prohibitions on insurance across state lines that create artificial silos. The overhead of insurance companies and people using insurance for all health care instead of just providing coverage for catastrophic needs inflicts bloat and overhead on even the most mundane of transactions. I've switched to a high deductible plan with a health savings account that lets me pay for my health care tax free so I negotiate with cash for the vast majority of my health care needs and let me tell you - the difference vs. going through insurance is eye opening. On top of that I no longer have to look for providers who are in network - I can pick whoever I want for whatever reason I want. Yup, it takes a bit more effort - but it's my freaking health. There are few things more important or worth dedicating effort to.