Just add my anecdote to the pile of "scratching my head about the messed up state of health care in the USA" stories floating around out there.
First off, I am insured, and I am healthy. Being self employed, there was a time when I was uninsured, but in recent years I have been covered. This past February, I switched over to an HSA (Health Savings Account) wherein I am covered for diagnostic and preventative things, I pick up the first $1250 of everything else, and I pay a helluva lot less of a monthly premium ($230 vs. $450). I also get to stick $2850 a year into a savings account (pre-tax) to use for the deductible as well as other medical stuff, it also rolls over into future years, and becomes something like a medical retirement account. All good.
Earlier this month I had a mammogram (clear, thankfully). My insurer sent me a claim recap. The procedure list cost was $572 bucks. My insurer covered 100% (diagnostic) but the recap documented their negotiated payment to the provider: $188.
So, being insured, I paid nothing. My provider got a measley $188 for the service. But had I walked in off the street, uninsured - my bill would have been $572. No wonder the uninsured are getting screwed; that medical costs are driving people into dinancial ruin.
I've had to pay for a few other visits, plus my prescription drugs, and in both cases, the insurance company negotiated rate was significantly lower than list price. And honestly, the whole "free market" thing worked for me; for years, I never really price shopped my prescription drugs - until I actually had to pay for them (out of my HSA account) - and so I switched from CVS to Target; the Target total prices are about what the CVS co-pays used to be when I was insured. I just went where it was convenient before; now I am price-shopping....