Americans pretend there are free markets in many industries
I figured it out myself when I traveled. The airfares in Europe and the Middle East are surprisingly affordable. I bought asthma inhalers in Lebanon, Turkey and Spain for about $3 each. Equivalent medicine in the US costs $85 per inhaler, $120 if you don't have insurance.
I was primed to notice an excellent Article in The Atlantic, "The U.S. Only Pretends to Have Free Markets." Here's an excerpt:
Internet service, cellphone plans, and plane tickets are now much cheaper in Europe and Asia than in the United States, and the price differences are staggering. In 2018, according to data gathered by the comparison site Cable, the average monthly cost of a broadband internet connection was $29 in Italy, $31 in France, $32 in South Korea, and $37 in Germany and Japan. The same connection cost $68 in the United States, putting the country on par with Madagascar, Honduras, and Swaziland. American households spend about $100 a month on cellphone services, the Consumer Expenditure Survey from the U.S. Bureau of Labor Statistics indicates. Households in France and Germany pay less than half of that, according to the economists Mara Faccio and Luigi Zingales.