That high-cost form of care adds up too. Here in Canada, publicly-funded health care — together with retail health care costs outside of the public system (like prescription drugs) — cost about 9% or 10% of GDP...I forget the exact number. By the same yardstick, U.S. health care is 13% of GDP. So tlhingan is right, the user-pay system *is* more expensive. Obamacare will have reduced U.S. costs a bit by now, but maybe not by enough to make a dent in the 13% figure.