Most people don't pay that much because of insurance. The point is, Americans (the long standing American Health system over engineers technology and over complicated it with bureaucracy. This leads to higher costs.
The American medical system is a joke. There are countries with far better medical care that charge a fraction of what it costs in the U.S. Not to mention the markup on life saving medicine that companies push on consumers. Just recently am American pharmecutical company got alot of heat for the insane markup on epipens which is ridiculous.
Spain is quite cheap to do certain things, but we had to abolish the right to universal health service because too many people came here to get their operations done freely. I think that except if you have the European Health Service card, they would charge you for everything if you need an operation plus recovery
It's cheaper because the procedure is much, much safer in the United States, believe it or not. If you get an infection, whatever insurance you have there won't cover for it. That's the reason why it cost so much more here than there and it's very unfortunate.
Some people need to understand that not everything is great about their countries. Even if you had to go for private sanitary in Spain, there is a minimum quality that the government expects; so the risk of infection would probably be similar to a public hospital
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