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We essentially have healthcare subsidy, which is part of why it's so expensive. The cost of service for those that don't pay, the uninsured, and even Medicare and other government regulated systems that don't cover the full cost of care ends up being shifted into insurance premiums and cash pay patients. The "book price" of any given service is well above the actual cost to provide it, but is negotiable depending on factors such as ability \ likelihood of being able to pay.
There's tons of factors playing into the high cost of healthcare. I had an eye emergency early this year and the ophthalmologist prescribed Combigan. It's a very small dropper containing a combination of medications that already existed and no longer have patent protection and it costs $300. When medications lose patent protection, the pharmaceuticals slightly change the proportions (recipe) of the concoction and it gains new patient protection status. Then they send drug reps in to feed the doctors nice lunches while they sell their "new" products...
I went back to the doctor and asked if there was a cheaper medication I could take since I have an HSA (pay out of pocket the first $4k). He asked me how much Combigan was, which is ridiculous considering there's probably a very limited number of medications an eye doctor prescribes, and Combigan is probably among the most prescribed in his office. He was surprised to learn it was $300 and prescribed me the old medication which was just as good, and costs $5.
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