The biggest reason healthcare is so unaffordable is that there is no price transparency, largely because there is a disconnect between the people using healthcare and the people paying for it.
I had a procedure done at my local in-network hospital, for which they billed the insurance company $17,000. The network negotiated rate is about 10 percent of that and the hospital wrote off over $15,000. Without insurance they would have come after me for that money.
If they are willing to accept $1,700, why not just charge everyone $1,700? You could say that they won’t collect $1,700 from everyone who has this procedure. Probably true. But why should uninsured people bear the hospital’s costs? If the procedure is truly worth $1,700 then that it what they should charge, and we should have a better system for socializing the unrecoverable costs.
I’ve had similar situations with lab work where the insurance company pays pennies on the dollar, but the lab won’t accept anything less than payment in full for tests that are not covered by insurance.
Contrast the price structure of procedures where most people have insurance with those that are not usually covered, such as cosmetic surgery. Cosmetic surgery is a standard marketplace with actual prices and some negotiating. Insured procedures are billed at exorbitant rates and preferred customers get massive discounts while poor folks are taken to the cleaners.