Some times, things really are that way. It does help to know the supplier, of course. But back to the article, there are some U.S. healthcare costs that don't

Some times, things really are that way. It does help to know the supplier, of course. But back to the article, there are some U.S. healthcare costs that don't make any sense, I've seen procedures with firsthand accounts of an equivalent service here in Uruguay vs the cost in the U.S., and the cost in the U.S. is an order of magnitude more (and service sometimes much worse, this is the hospital I go to, try to argue it's worse than an average U.S. hospital ! http://www.hospitalbritanico.org.uy/ http://www.hospitalbritanico.org.uy/ ). Similarly, the company I work for regularly gets better software for one-tenth the price of U.S. bidders, we've bought local (Uruguayan), Colombian, Ecuadorean... it does help a lot that we know the language and how to do business there. It's not a hundred-to-one comparison as you mention, but there are huge market inefficiencies (in this case, they should be arbitraged away by someone selling services in the U.S., with a focus on quality and not devolving into Infosys or something).