because you need it in the us to interface with the medical system at all. you literally cant pay out of pocket sometimes and even if you can all places charge more out of pocket than they do to insurance as part of their deals with insurance companies (insurance agrees to pay x amount of they agree to make the out of pocket price y amount). this is to force people to get insurance. so insurance companies drive up the price of healthcare and also make deals to coerce people to need to buy insurance (including lobbying the government to tax people with out it). in california the state medicaid is nearly 30% cheaper per capita than the national average. private insurance middlemen literally make health care cost 30% more than a bloated government bureaucracy.
United States