Uhm because they, in reality, are not?
Because they and all the rest of the world come to America for their Heath Care?
You are making a mistake to connect affordability to Quality of Care, as in to prove the American Health Care is not the best in the world.
But the answer to the question you should have asked, is there is a 3 legged stool.
Leg One, Patients, they go to the health care system and at any opportunity, they will go for the WIN. Meaning, if they have any insane reason to do so, they will bring litigation vs the Doctor, the Nurses, the Hospitals, the suppliers of bed sheets if necessary to be able to cash in on their Lottery Ticket.
Leg Two, Doctors and Hospitals, The cost to be either one is astronomical, in part because of the malpractice insurance and (for hospitals) the absolute need to have the best toys in the world even if it can never ever pay for itself. Why? Simple if they do not then they do not get the business.
Leg Three, Insurance Companies. What can one say, they sit in the middle and take advantage of both sides. They win no matter what. If the Legal System succeeds in a 100M Law Suit because a nurse put on the wrong bandage, even though that had no effect, then the Insurance Company simply raises the insurance rates FOR EVER. They always win, no matter what.
You think this is outlandish? Well think again.
A Woman has headaches and her Doctor can not determine any reason why.
The Doctor prescribes a CAT Scan.
The Woman goes and has the CAT Scan.
It shows absolutely nothing out of the ordinary, every one is rather puzzled why the Woman is having the Headaches.
The Woman files suit against the Doctor and the Hospital. Turns out she is a Psychic/Terrot Reader, Palm Reader, Astrologer etc. She is aledging the CAT Scan has destroyed her abilities.
Are you ready for the results?
She wins a $1,000,000US settlement. The Defendant could NOT PROVE that the CAT Scan could NOT destroy said abilities. The Woman had several .... customers testify that she was legitimate.
You have the answer to the question you really wanted to ask.
Different context.
A Hospital admits an 85 year old woman, even to the casual observer (me) she is dieing.
Looking at the records one sees $800,000+ US in test were ran on this woman within 24 hours. She is now dead. Looking through the ancillary medical records no evidence of any tests being performed.
Sounds bad doesn't it.
Now, 45 days later, the checks come in for the $800,000+ bill to Medicare/Medicaid, total $8,000. I talked to the Head of the Hospital about this, he said it was the only way they could cover the free work being performed on the Walk Ins.
You have the answer to the question you should have asked.