We spend so much because mostly we're spending other people's money, and no party is really in a position where cost control is possible and beneficial. The pa

We spend so much because mostly we're spending other people's money, and no party is really in a position where cost control is possible and beneficial. The patient might prefer to pay less out of pocket, but they often aren't presented with cost information until a month after the service. Often nobody can tell you how much something costs before hand. Anyway, there is incentive to get more covered care, because insurance is paying for most of it. Insurance companies are generally limited on administrative costs and profit to a % of medical costs. More costs allowd them to pay higher executive salaries and profits. Insurance companies do have a cost control function, but the incentive isn't there to do it well. Individual practitioners and medicial facilities and facility groups have incentive to bill more things. People paying for the insurance, which is often employers, do have cost control incentives, but things are pretty murky at that level. Somewhere in all of those costs, we're paying for an army of billing specialists and an army of claims handlers. Throwing out insurance and moving to billing at time of service would be terrible for access but it would make cost control a lot more possible. Single payer systems can make cost control possible too, if the single payer system is able to do analysis and effectively set policies to avoid things that are not cost effective, and curtail billing abuses... Of course, nobody likes it when cost control says the thing they want to do isn't cost effective and they can't do it.