In addition to wages and salaries for doctors, nurses, and medical personnel, the American health care system has to provide profits for private hospitals, diagnostic centers, insurance companies, and for the accountants, attorneys and management consultants made necessary by the enormous litigation and regulatory compliance cost. American medicine is the most regulated in the world and the most criminalized.
And another big factor is that the rest of us have to make up the difference for the patients that are not profitable.
It has gotten to the point where some doctors in certain kinds of practices barely make any profit on Medicare and Medicaid patients. In fact, in many cases doctors actually lose money treating them.