Well as an American who uses insurance, the issue is not the insurance, but the user. Really you have two options when choosing a plan for cost, higher premiums or lower premiums. Now higher premiums = lower out of pocket expense, lower premiums = higher out of pocket. People look at the front end and not the back end, nor do they actually use things like HSAs and FSAs to their advantage. Lastly he went to the ER for stitches and not urgent care (which probably would have been 50% less than a ER visit and is the more appropriate location to go unless you cut your finger off.) the reason why facilities and insurance charge more for the ER is bc 90% of the patients are not in emergent need, so they are trying to get the patient to go to the lower cost option.