A front-page article...

...in the Sunday Times gave a hint as to why health care costs are so much higher in the U. S. than in other developed countries. In Europe and the Far East, single-payers have more bargaining power than private insurers or individuals. So just like Wal-Mart does with its suppliers, they determine what a procedure, like a colonoscopy, costs and then tack on a fair profit. From the piece (my emphasis):

Deirdre Yapalater’s recent colonoscopy at a surgical center near her home here on Long Island went smoothly: she was whisked from pre-op to an operating room where a gastroenterologist, assisted by an anesthesiologist and a nurse, performed the routine cancer screening procedure in less than an hour. The test, which found nothing worrisome, racked up what is likely her most expensive medical bill of the year: $6,385.

That is fairly typical: in Keene, N.H., Matt Meyer’s colonoscopy was billed at $7,563.56. Maggie Christ of Chappaqua, N.Y., received $9,142.84 in bills for the procedure. In Durham, N.C., the charges for Curtiss Devereux came to $19,438, which included a polyp removal. While their insurers negotiated down the price, the final tab for each test was more than $3,500. 

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But she noted that gastroenterologists in Austria do have their financial concerns. They are complaining to the government and insurers that they cannot afford to do the 30-minute procedure, with prep time, maintenance of equipment and anesthesia, for the current approved rate — between $200 and $300, all included. “I think the cheapest colonoscopy in the U.S. is about $950,” Dr. Ferlitsch said. “We’d love to get half of that.”

Dr. Cesare Hassan, an Italian gastroenterologist who is the chairman of the Guidelines Committee of the European Society of Gastrointestinal Endoscopy, noted that studies in Europe had estimated that the procedure cost about $400 to $800 to perform, including biopsies and sedation. “The U.S. is paying way too much for too little — it leads to opportunistic colonoscopies,” done for profit rather than health, he said. 

And here's the link to the David Frum post which made the comparison with Wal-Mart (again, my emphasis): 

...what American healthcare needs is a merciless Sam Walton figure who will brutally tell hospitals, "That $1200 toenail clipping and test? It's now $87. Take it or leave it. And if you don't take it, I'll find somebody else to take it."

I'd prefer that this hypothetical healthcare Sam Walton be a private company operating in a competitive marketplace. But it's going to have to be SOMEBODY, and if it's not "Mr. Sam," it's going to be Uncle Sam.

P. S. I couldn't resist one last shot at W.