You mean back in the 1930s when you stuck your foot in a wooden box with an open X-ray tube and got yourself and nearby customers exposed to radiation at a significantly higher dose than even a full torso x-ray in modern times? Okay, my guy...

You’re right about that, but cost is a funny thing. The x–ray photograph itself costs mere pennies, especially with a modern digital imaging system. Even x–ray film is just an incidental cost.

However, when you are getting an x–ray to diagnose a medical problem, you do want more than just the image itself. You want the person who takes the x–ray image to be practiced and able to reliably take the correct image with the correct camera settings and so on. But most importantly, you want the diagnosis to come from a highly educated doctor who knows what your insides are actually supposed to look like. Whether these two roles are handled by one person or multiple, you are monopolizing someone’s time. You can’t really expect them to take x–rays of multiple patients at the same time, or to look at two x–rays and diagnose them both simultaneously.

If it takes the imaging tech 10 minutes to set up the x–ray machine for you and make the images the doctor asked for, then you have to pay 10 minutes of that tech’s salary. If the doctor spends 20 minutes asking you questions about your injury and then 10 more minutes looking at the images and telling you that you will live, then you’re going to have to pay for half an hour of their salary. The staff at the front desk who hand out forms and answer phones get a slice. The nurses who do most of the grunt work get a cut too.

The shoe salesmen didn’t directly charge for use of the x–ray fitting machines, but they did recoup their costs out of the shoe sales. Either by increasing the price of every pair of shoes by a small amount, or just by selling additional shoes (due to the novelty factor, or because it genuinely saved time allowing them to sell more shoes in a day).

The bulk of the price of any good or service comes from paying the people.

I live in one of the highest–priced areas of the US, and a simple x–ray exam costs about $200 whether you have insurance or not. The difference in price is primarily due to the higher cost of living here than in Brazil; the tech who takes the x–ray and the doctor who looks at it to diagnose the problem get paid more here than there. I should know; I got hit by a car last year and sprained my thumb when I hit the ground. The x–ray was to check that the thumb was only sprained, and not broken.

But if you go to a hospital to get the same thing you will pay 10× as much or more. You’ll also have to wait a lot longer, as anyone with a more serious complaint will get prioritized ahead of you. Both of these are reasons why people should not generally visit the hospital, unless they have a problem which is immediately life–threatening, or they are admitted to the hospital by their primary–care physician.

> why should having minor health complications be synonym to bankruptcy in the richest country in the world?

It’s not. For all of the problems that our health–care system may or may not have, people don’t go bankrupt because they needed an x–ray.

There is no good reason the US can't bring down healthcare costs, but there are also some not so good reasons that some countries have very cheap healthcare.