In some cases there is less regulation, in others a lot.
The policy price differences in each state are evident of this.
The main difference between the U.S. medical market and other countries with less costly systems, is that the countries with less costly systems tend to ration care by restricting supply.
Not enough to hurt a lot of people, but enough to restrict the availability of some care.
That presents another cost problem not factored in to the equation, the time lost waiting for some services.
It's an unmeasured opportunity cost.
Getting that knee surgery in 2 weeks vs. waiting a month or 2.
How much does it cost the economy to have that person being unproductive, then multiply it by the number of people who have to wait for these not serious but necessary services.
Democracy has it's downside and that's when the voters wants, conflict with the state's finances.