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Yikes, that's a comprehensive list from the FTC. Health care ... hmm. You open a lot of loopholes with your points. Health care I would assume is predominately insurance, but does health care insurance fall into the "insurance" category or the "health care" category? If it falls into the former, what is health care spending? Great question, I think you're right that it's got to be prescription medicine in large part, which of course would bring those numbers under fire. It could also, however, be services rendered beyond what is insured (an extremely common medical expense for Americans) -- and those services are almost certainly American. I don't know enough about the subject to weigh one over the other.