The US also does most of the innovation, develops most of the drugs, equipment, devices, and treatment regimens, and/or improves on or develops feasible products and treatments based on foreign research and development elsewhere.
Most of drug R&D is done as basic research in universities. Drug companies do do research, but their marketing budgets are higher than their R&D budgets. A large portion of the research is looking for baldness-cure/dick/sex pills, along with a substantial sum spent on patent work-around research which isn't setting out to create anything new, just do the same thing in a new way to work around someone else's patent.
The cost of the drug R&D you are talking about (aside from publicly funded NSF/NIH research) is minuscule in comparison to the healthcare spending expenditures we are talking about. Device/procedure research is even less of a blip.
