It's a simple statistic....using 2016 data, the average cost for an American (per capita) is $9,892. Same data source, 2016 info, for a German (per capita) is $5,551. Why?
Having been around Germany (off and on) for over 20 years of my life, I will offer six reasons for the pricing difference.
1. If you go around to the top fifty urbanized areas of the US (Baltimore, Atlanta, Memphis, Miami...in particular), and look through the normal monthly shootings, stabbings, and assaults....It's a fairly productive 'scheme' to get folks inside the front door of an emergency room, and start the dollar-machine for high-cost acts to save your life. You go and look at the top fifty urbanized areas of Germany, and it simply doesn't match up. I do agree.....Berlin, Hamburg, and Frankfurt....can be a bit violent....but it's simply not a match to Memphis or Baltimore. So you have fewer 'customers' using the emergency services of German hospitals for violent acts.
2. The 'governor's board' for German healthcare. The board can meet and discuss changes to public care expectations, add new drugs to the system, and mandate pay levels/profit levels for clinics and hospitals. If you had a national board in the US....it would limit cost. At the same time, the board might not qualify certain drugs under the plan (maybe for several years), and if you felt this was a wonder-drug, you'd pay for it out of your own pocket (that's a negative).
3. Drug-overdosing. In 2016, there were only 1,333 drug overdose deaths in Germany (82-million population. It's not to say that Germans do less drugs....but their chief pick circles around marijuana and ecstasy. I'll admit that opioids are coming along in Germany and might be a major deal in the next decade, but right now.....the statistical data from the EU suggests that are only around 150,000 users in Germany.
4. Diet. Most American's who've been to Germany for a military tour, will note that there's a lot of pork products in a typical German's diet, and that usually has consequences. I won't argue over that point. However, there's been this trend for several decades of a fair number of Germans who eat 'healthy'. By this, I mean they are eat a low-fat diet, consume the bad foods in moderation, walk or bike on a daily basis, and tend to avoid a lot of potentially dangerous activities.
5. Unintentional exercise. If you were to go and partner up with a German to see their typical day.....you might find that 'Johan' walks from his front-door to a bus pick-up point (a 5-minute walk) to reach the bus, which takes him to the front of the train station. Another five-minute walk occurs, then you'd ride into the main city where he works.....where'd he'd walk another five-minute piece, and finally the last 300 steps to the front door of the office. In the evening, he'll return the same way, and you can calculate that 'Johan' did roughly 2.5 miles in the mix of the entire day. No, it wasn't intentional or planned this way....it's just the simpler way of avoiding traffic and stress of driving.
6. Rehab. The health insurance 'controllers' ensure that rehab is listed as one of your options, but they also ensure that this clinic has a rating or a success rate. If you fail to complete the rehab and come up a year or two later....wanting to try rehab again, it'll be discussed and the controllers will want some substance to the idea you might stay this time. Otherwise, no.....a 2nd rehab won't be on the agenda.
To say it's cheaper in Germany.....doesn't really tell the whole story. It's just that the pieces and parts to the German system aren't used as much, or depended upon as much.
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