The primary factor (in my view) is that we pay healthcare providers (doctors and nurses) 2x to 3x as much as other developed countries.

That creates knock-on effects throughout the healthcare system:

* Doctor time is worth $xxx/hour, so every second counts. We hire a bunch of support staff to make sure doctors aren't "wasting" time on paperwork, taking vitals or talking to patients. Now it costs more to run a practice.

* Doctor time is worth $xxx/hour, so we need to make sure that health insurance only pays for procedures that people truly need. That leads to insurance companies hiring a bunch of doctors and nurses to adjudicate claims (that's expensive, plus fewer doctors practice medicine). It also leads to denied care.

* Doctors have a lot of money, so if a procedure goes bad and you want to sue someone, they make a juicy target. Now you have higher malpractice insurance, so doctors bill even more.

* Doctors are afraid of being sued (see previous), so they often order more tests than necessary to prove they are providing adequate care. Those tests cost money.

The cause of high doctor salaries is an artificial shortage of doctors. Medical schools collude to limit the number of medical students who matriculate each year, which squeezes supply.

We could very easily fix the American healthcare system in about 10 years by simply allowing doctors and nurses trained in other developed countries to practice here, plus forcing medical schools to accept more students.

Regarding the latter, there is no shortage of qualified applicants:

1. Nearly everyone who starts medical school finishes. Matriculants are so statistically overqualified that hardly anyone washes out.

2. Medical schools have silly-stupid entrance requirements which have little to do with being a good doctor. Beyond GPA, you need many hours of volunteer work outside of class, extracurricular activities, and often research experience. These admissions requirements are imposed because there are simply too many qualified applicants for the number of slots and med schools need some "fair" way to cull the herd.