because we are the best in the world.
That's true, but the tradition of excellence developed under a relatively free market system. As that disappears, so eventually will the excellence.
PS When I was a kid there was no such thing as an HMO. Most people had catastrophic medical insurance, and everything short of something like a heart attack, cancer, or a car accident, was paid out of pocket, so everyone wanted to know what everything cost, the providers knew and informed them, and most people looked for the better deals, thus keeping a constant pressure on the medical profession at every level to keep costs low and business models efficient. As a result, medical costs were fairly cheap, as was insurance.
