Actually the three things you mentioned are not big effects. The bigger cost drivers are:
Well you're wrong, I guess. My sister runs 5 hospitals and there's loads of doctors in the family. I hear about this crap constantly, and these are the COMPETENT doctors not the 2% who account for 98% of all lawsuits. They want malpractice insurance abolished. Bad doctors and hospitals want right to sue abolished.
1) Defensive medicine (driven somewhat by malpractice suits for sure) - we spend more than any other country on expensive tests with virtually no chance of detecting anything - just in case.
In most countries you just die if you get something serious. Don't buy any hilarious comparisons saying how great medicine is in [fill in the black] country. Medicine is so great in sweden but they have way more actual mortality than spain which is practically third world. Some of that is just genetics but a lot of it is due to lies. They die of heart attacks 3x more for example and it is NOT "environmental" in any way, shape or form.
Every other country is very dishonest about how they perform, and the more state run it is the more dishonest the reporting becomes because they are basically policing themselves! They will point to a slightly higher success rate in heart surgery but fail to tell you if people have risk factors they don't get an operation, and they don't perform the right diagnostics so loads of people die before they have any idea anything is wrong.
Also, this is insurance company propaganda. They want to cut costs, and easiest way it to just not treat people at all. And that's how socialized medicine works. Your whole medical system is one giant HMO and everyone gets the same (terrible) treatment, while at the same time they publish government studies saying how great it is!
2) I don't know what an MMO is, HMO maybe? But definitely the shift from insurance being insurance to being 'cover every healthcare cost I have' has caused more bureacracy than anything else, and hence driven expenses up. (it has also caused people to be lest judicious in choosing their healthcare)
Whoops HMO, the other horrible thing with MO in it. Crushed the quality and driven up malpractice insurance costs.
3) Medicare/Medicaid - Because of the way that medicare/medicaid reimbursements work, providers have no choice but to overbill private insurers, which then causes more bureacracy as they 'negotiate down', and also allows them to charge more for things than they used to since they can get away with it
But you said that insurance wasn't the problem. Medicaire IS insurance. This is exactly how insurance, or the way insurance is now, has messed everything up. They cut backroom deals about prices and it makes everything out of whack. Insurance should be a percentage paid. Right now you will pay say 1000 to a doctor for a procedure then find out they only reimbursed him 200, giving him a total of 1200. So you paid 200 a month and after 5 years you get reimbursed just 200 to the doctors. Plus for big expenses they cap the amount they will pay so it no longer is useful for serious catastrophes like cancer or car accident, which is the entire point of insurance in the first place!
So what was the point? But if you don't have insurance they charge 10k. This price discrimination needs to be made illegal and then everything will sort itself out.
4) Big Pharma spending more on advertising than on R&D.
That doesn't really matter. The real problem is they are trying to force grandfathered medication to become patented and renewing patents. Nobody is forced to use patented drugs, though. If you don't have people pay for new drugs and pay a lot, they don't get developed.
If we took attitude of euros and didn't let them charge, all research would grind to a halt.
5) Abuse of ERs buy the uninsured and elderly. Its the most expensive form of healthcare you can get and legally they are unable to turn anyone away. Go to any ER and you will see a solid mix of illegal immigrants using it for basic medicine (fever, upset stomachs, etc.) and elderly for attention (you know its a problem when people in the ER know an elderly person on a first name basis). Both of those are of course symptoms of other problems in society, rather than a direct driver of health care costs.
But all these costs are BS anyway. They just make up whatever prices they want based on the previous stuff mentioned, back room deals etc.
It still only costs 50 bucks to have a patient looked at by a doctor, no matter what the hospitals say.