I have done a lot of research into this area. Obesity and other self inflicted health issues are definitely a factor, but not, by far, the whole picture.
Our cost per service is 2-4x or more, and the larger reliance on specialists creates significant complexity and even more costs. So, we do spend 2x, but we get 1/3 to 1/4 of "care" per dollar. In other words, we get less actual care. And the care is biased to fixing things as opposed to preventing things. And it is also biased to those who are wealthier.
Some of the cost drivers:
- Administration is 25% of costs, far less in other countries. Insurance company profits and complex administration with confusing and overlapping methodologies that obfuscate costs and comparisons.
- Capital costs are 25% of costs, far less in other countries. Multiple, private, and overlapping hospitals demand more capital and private capital with its expected returns
- Doctor compensation is 2x to 4x more, nursers 2x. Specialists here get truly rich, not true in other countries.
So, quite a lot of the extra spend is not efficient, and goes to insurers, owners of hospitals, and doctors.
I also have personal experience. To get a simple ultrasound, you are talking about $450 for a primary care visit to get a referral for a $650 specialist to get a $1000 ultrasound ($800 scan plus $200 reading), to get a $650 follow-up visit with the specialist to discuss the results. That is almost $3,000 of actual out of pocket costs to me, with a good insurance plan ($2K per month for a couple), the "claimed" costs were significantly higher. MRI and CT are even higher. Similar for a broken ankle, which cost me over $4000 out of pocket.
I am, relatively speaking, well off compared to average, and was able to do this, but that hurt, and significantly disincentivizes me in the future.
Our health system is broken, and pumping more money into only makes it worse.