Because the relative costs are so high, the healthcare system of the United States is the subject of much scrutiny, analysis, and criticism. Other countries have the same or better outcomes with significantly lower costs. Health care systems, however, are a reflection of the societies they serve. They develop over time within a framework of the collective national experience. The American approach is unique in that it has relied much more on market-based solutions to healthcare issues. This article provides an overview of the healthcare systems in Canada, Germany, and Japan. It then discusses the significant factors that drive the higher costs of the American system, starting with a review of the general aspects of Markets. American hospitals, the pharmaceutical industry, malpractice costs, private insurance, Medicare and physicians are then placed in historical context to give the reader a broader perspective of United States Healthcare Economics.