Countries have choices. Provide plentiful basic care or spend billions on the tail ends of probability diseases that only 8 people have. Affordable insurance premiums, or billions to line the pockets of pharmaceutical companies. The US (lawmakers) have made those choices. The rest is just details.

(There is also a wage multiplier factor. Simply converting the prices between currency doesn't account for that. You will find that many things cost multiples in the US what they do in Peru. They're not all from broken markets; it's just a high wage country so local inputs are expensive.)

Countries have choices. Provide plentiful basic care or spend billions on the tail ends of probability diseases that only 8 people have. Affordable insurance premiums, or billions to line the pockets of pharmaceutical companies. The US (lawmakers) have made those choices. The rest is just details.

(There is also a wage multiplier factor. Simply converting the prices between currency doesn't account for that).