A) It's the most expensive because we subsidize almost 100% of medical research. When we go "nationalized" who's going to foot the bill for that?

B) It ranks low on outcomes because we put enormous efforts into saving the poorest, oldest and sickest people. Most foreign nations ration care so their "success" rate looks better than ours. The same effect causes our teaching hospitals (which have incredibly good care givers) to have worse "outcomes" than the typical community hospital.

Why don't you just defer to my better knowledge on this...