In 2012 I was advised by my cardiologist that my heart beat irregularities were such that I urgently needed a pacemaker. I was not a part of the French health care system but had retained my old American Foreign Service insurance(AFSPA) which reimbursed us for coverage in France. We went to a private clinic in nearby Lannion and I received a top of the line American Metronics pacemaker, with the surgery, hospitalization of three days costing $2,800. We paid this and the AFSPA happily reimbursed us. They informed me that in the US they and Medicare would have to pay between $25-30 thousand for the same procedure. The private clinic in France presumably made a nominal profit. So my question is why are costs in the US ten-fold higher? Roy