The major difference between European health care and American health care is that Europeans receive care closer to At-Cost than their American counterparts, who demand enormous overhead and profit. A band-aid in an American hospital can bill for $50. An IV can run you $1000. These enormous fees have nothing to do with the kind or quality of care (you can find price gouging in the dingiest rat-hole ERs right alongside Mayo Clinics). They’re set by the hospitals because patients have no bargaining power, while state agencies have enormous latitude in setting flat rates.
That’s also a big reason why American hospitals hate Medicaid patients (but love Medicare payments). Medicaid has a much tighter fee schedule than Medicare, so you can bill for more and at higher rates. Hospital admins in the states will argue they can’t turn a profit on Medicaid (highly dubious, since “profit” for the office includes covering the inflated borrowing, real estate, and administrative costs the facility has to absorb). Meanwhile, whole practices exist to serve Medicare patients.
When countries, like the UK and Germany, begin outsourcing and privatizing their medical procedures, the prices rise to whatever limit the state is able to absorb. UK’s current NHS cost crisis is being driven largely by the exploding cost of privatized and outsourced procedures, combined with an aging population that has elevated demands. That’s where you see the most expensive health care in Europe.
By contrast, state hospitals in Italy and Norway are dirt cheap to operate when they’re not on the hook for these extortionary private costs. Suddenly you’re not getting charged $150 for an aspirin and caring for a baby in the NICU doesn’t cost half a milly. The state budget isn’t getting broken over the back of privatized profit-seeking care.