That's because the costs are negotiated centrally, so healthcare is relatively cheap even if you have to pay for it. Some European countries are even having problems because some Americans found out that it's often much cheaper to pay for a plane ticket, a nice hotel, and the treatment costs fully out of their own pocket in Europe than having the same treatment in the US even with insurance.

I take adhd medicine in Germany that I also took in the US. In the US, I had to pay $50 for a doctor’s appointment, ~$200 for a drug test to make sure I was taking it and only it, and then $220 for one month of the generic brand. Then, when I hit my deductible in about June, the drug test was free, my appointment was $30, and the medication was $50. For this privilege, I paid $13k/year in premiums. In Germany, I get insurance for about €140/month while working part time at a bakery, then all my required appointments are free, no drug test, and I get two months of the brand name medication for under €16.

I was making over $60k/year in the US, not living in a major city. I now earn a few euros more than minimum wage at a part time job in Germany. Things are significantly more affordable here.

One of the most surreal experiences in my life was riding in an ambulance in Norway and having the EMT sheepishly explain that while the ambulance ride was free, the ER visit was going to come with a bill. He was equal parts embarrassed and indignant about it. The bill was the equivalent of $25.

Of course health care in Germany is magnitudes better than in the USA. But there are some weird exceptions to coverage. For example everything around teeth and some things regarding eye sight and allergies. Apparently not having my eyes and nose swollen shut all the time is a life style choice which costs me ~50 bucks a month. At least they think I should be able to breathe which only costs me ~5 bucks every 4 months (north of 300 without coverage).