Drugs eat up a tiny fraction of total medical cost. If you dig into the breakdowns of where money is spent, and look at other countries, you'll find we are more expensive at every step. This includes doctor and nurse salaries, and litigation costs. It includes forcing drug companies to lower costs, which will reduce R&D since many rare conditions need high cost drugs to cover the R&D to bring a drug for a few people to market. It includes forcing everyone to pay into the system, so the insured aren't paying the medical bills of the uninsured emergency visits, which is proving difficult to do. It would involve denying care to those costing too much, which we do to some part, but not like many countries.

If you want to make our costs similar to other countries, we'd need to lower costs at each place, including doctor and nurse salaries (which will be politically impossible), cap litigation (which consumers complain about), and dozens of other components.

There is no one area that is the cause. It's death by 1,000 papercuts.