So I get that by cutting out the insurer you are saving some funds, but where does the rest of the difference come from? Are the hospital rooms and surgeons so much cheaper because everyone in those countries pay them rather than just the few people who actually use their services?
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Some possible reasons:
* The hospital system in Belgium is 99% either state or non-profit owned. Less sticky fingers. Less luxury.
* Infrastructure (buildings, tools, ...). The infrastructure is extremely heavily state subsidised.
* Medical professional wage negotiations. Medical professionals earn quite a bit less in Belgium than in the US. Quite many (most?) medical pros actually seem to have their priorities right: helping people solve medical problems.
* Choice. In Belgium, people, not insurers choose the hospital they go to, based on reputation and perceived quality.
* Volume. Healthcare in Belgium is fairly accessible, probably one of the most accessible in the world. This means few people putting off operations for financial reasons, so higher volume.
* State subsidies spilling over to foreign patients in unintended ways. I could very well imagine some of the marginal cost of an operation on a non-resident American citizen also being carried by the state in other ways.
Two anecdotes, logical consequences of this system.
1) My (poor by US standards) 90 years old neighbour had a hip replacement at the age of 86, 100% paid by the state.
2) An aunt working as a nurse told me about a phenomenon that was quite common until a few years ago: "winter rabbits", old people "dumped" into hospital for several weeks even if they were not ill. Relatives dumped them at the hospital as a (to them) low cost way of getting rid of them for a few weeks while on holiday for example.
I've lived in Scandinavia, with largely similar systems (they vary a bit, I've seen Sweden and a bit of Finland). The health care systems are centrally planned and administered, and hence have the typical problems doing the work in an efficient manner.
For instance, it is acknowledged in international comparisons as really hard to get diagnosed because doctors just don't have the time, largely because of administration. Me and others I know have had years and decades of lowered life quality from easily cured problems like bacteria infections, simple knee problems, allergies and iron/vitamin deficiencies.
I've heard good things about the German health care system.
Notes: I have also lived a few years outside of the Nordic countries, so I have some perspective. And I agree that the US system seems the craziest one on the Western world.
Edit: The government has recently decided that all illegal immigrants in Sweden will get free health care, without any paperwork. If you need an expensive and can fake an Ukrainian accent in English, or something similar, there is a cheap solution for millions of Americans with a ticket to Sweden...
"The government has recently decided that all illegal immigrants in Sweden will get free health care, without any paperwork."
If the vast majority of people treated are not subject to itemised accounting, the bureaucratic expense of having itemised accounting for one small group can actually be higher than just treating them for free as well.
Not for expensive operations costing 10K++ €. The administration of those payments is already set up for e.g. tourists that get sick.
Since it seems I need to explain in more details:
The problem is that potentially anyone which can get to Sweden can get expensive treatment free. This is potentially ruinous for a small country. Just the millions of poor gypsies in Romania/Bulgaria which lack good health care for poor people ("I'm from the republic of Moldova outside the EU. I am here illegally because criminals are after me") is enough to break the Swedish health care system if they use this loophole in an organized way. Or normal citizens in those countries, for that matter. We will see...
The fundamental problem is that everyone in the system benefits from spiraling costs, and so they make them spiral in ever more egregious ways.
Everyone benefits? Well, higher costs are obviously better for hospitals and doctors, but don't insurers want to control costs? Not really. As long as insurers pass costs through, the more they pay, the more they can get away with charging, and the bigger their profits can be. Insurers want predictable and rising costs, not low ones.
How egregious is the inflation getting? Let me give you an example. From the mid-90s to now the cost of childbirth tripled. See http://www.nytimes.com/2013/07/01/health/american-way-of-bir... for confirmation. In England there was controversy because the royal childbirth cost over 2x what the average childbirth there does. It still cost half the average US childbirth.
And no, Obama's plan does not address this issue. It says that insurance companies must spend at least 80% of premiums on health care. If I was an insurer, I'd look at this and see fraud as an opportunity to have the 20% slice which covers my costs and profits continue to rise, and put out effort to catch exactly enough fraud to keep the amount paid out at exactly 80% of the premiums that I collected.