Donald Savastano, who lived in upstate New York, won a $1 million lottery from a scratch-off ticket in late December. He planned to buy a truck, possibly go on vacation and fund his retirement. But he also wanted to use his winnings to finally see a doctor. He couldn’t afford a visit before because he didn’t have insurance, according to a cashier who worked at the store where he bought the winning ticket.

A visit to the doctor led to a diagnosis of stage 4 cancer. He died 23 days after winning the lottery. Savastano, 51, was a self-employed carpenter who learned the trade from his father, according to his obituary.

Savastano’s story caught the attention of Sen. Bernie Sanders, a vocal supporter of moving the U.S. to a universal health care system.

The average American spent $10,348 on health care in 2016, according to reports from the Centers for Medicare and Medicaid Services

Individual health insurance premiums without subsidies under the Affordable Care Act (ACA) averaged $393 a month in 2017, according to ehealthinsurance. The deductible for an individual averaged $4,328. Family premiums without subsidies averaged $1,021 and the average deductible was $8,352.

People with low incomes qualify for access to government subsidies under the ACA, making their health insurance cost much less depending on how much of a tax credit they qualify for. Medicaid and the Children’s Health Insurance Program (CHIP) also offer subsidized health insurance.

Though it is unclear what type of plan — through the ACA marketplace or government coverage like Medicaid — Savastano could have qualified for, his story shows the issue with how costly U.S. health insurance is in general.

There are many reasons health care in the U.S. is expensive compared to other countries. According to JAMA, health care spending in the U.S. increased by $933.5 billion between 1996 and 2013. This increase was largely due to higher health care service prices and intensity of service needed. In fact, the U.S. has the highest cost (by a large percentage) of services of any country, according to The Commonwealth Fund. Other factors in the JAMA article included an aging population and overall population growth.

According to CBS, other factors making health care expensive include Americans wanting the most up-to-date technology, which is typically provided despite it being costly and not necessarily better than older options. Doctors tend to practice “defensive medicine,” which means ordering a battery of tests to protect themselves from malpractice lawsuits. Both of these factors could contribute to higher health care prices.

Other price-increasing factors include restrictions and regulations from the government such as making nurse practitioners, who can charge patients less, only able practice under the supervision of a physician, and that patients do not know the price of a health service until after they’ve received the service.

Despite having some of the best medical technology, America cannot equate its expensive health care to better health outcomes for Americans. According to The Commonwealth Fund, the U.S. has the lowest life expectancy of Western countries and the highest infant mortality rate. Chronic diseases are also more prevalent in the U.S.