There’s a vast amount of healthcare spend that’s not made under duress. Non-US systems have embraced the free market here as a means to control cost. The common example I throw out is that France publishes a list of reasonable and customary costs for common outpatient treatments. Your insurance will reimburse you 80% of that. If you want to go to a doctor that charges 10x that, well, that’s your choice and your money. With cash up front operations, doctors don’t require a huge staff to interface with insurance. They also don’t have to build in extra cost to deal with float and/or possible non-payment.

Emergency care and care for the truly poor is handled with a different process.