If you know anything about the US health system, you know that it's expensive. Just expensive in general. It's not readily apparent just how expensive it is, beyond the general notion of expensiveness - it's just expensive in the abstract.
Thing is. For the cost of a US hip replacement, you can:
Go to Spain
Get a hip replacement
Live in Spain for a while
Go to Pamplona and run with the bulls
Get trampled by the bulls
Get a hip replacement replacement
Go home to the US and use what's left to live comfortably unemployed for a year
Invest in some hedge fund that speculates on the repayment rates of poor people
Which is both absurd and insane. And, to boot, it's a perfect example of why poor people have to pay more for things than rich people.
If you are rich, you can just go to Spain and do these things, no ifs or buts. You have the money for it. However, if you're poor, you don't have the money for it. It's not either an expensive US hip replacement or a cheap Spanish one - it's either the expensive option or nothing at all. The only entrance point into the health care system is through the gate of expensiveness, and if you need that health to live, you're forced to take that route. There is no alternative.
The same general principle goes for other things in general, too. Terry Pratchett famously used the example of boots - sturdy boots that last for years and years are expensive, and out of reach for those who cannot afford them. They instead have to contend with cheap boots that fall apart after a short while, and have to be replaced regularly. The net effect being that poor people have to spend more on boots over the years, since they constantly have to act within their means and buy the cheap ones over and over.
One could argue that they could do without boots for a while and get the expensive ones after having saved up. Thing is, that's not how feet work.
You can save a lot of money if you're rich. Not because of any inherent virtue or talent, but because you have the option to not waste money on things that do not work.
