I'm not surprised at all. If you compare individual US states to other countries, some parts of the US south have worse healthcare systems than third-world nations. The US is by far the worst health country in the OECD.
You'd have to normalize those numbers. It doesn't mean the same thing if the US spends a billion dollars on 1 million procedures when a more civilized society can do those same million procedures for 300 million.
If Medi-* actually worked properly that wouldn't be happening.