The reason pricing isn't available is because that's negotiated between the provider and the insurance companies.
Since most patients are using insurance, hospitals have to negotiate with some of the major insurance providers.
Insurance companies do not want hospitals have transparent pricing, since they want people to buy insurance. Insurance companies also want uninsured people to pay a higher price, again, so people buy insurance.
People can't choose their insurance providers because it's tied to their employment (in most cases).
The market settled on this extremely convoluted system, which makes no sense to outsiders, specifically because it's so profitable. The only way out of it is through regulations that prohibit certain anti-competitive behavior, or for the establishment of competition in the insurance segment, which has no profit motive (and who would start a business with no profit motive?)
Most parties kind of like the status quo. Insurance companies collect from employers, rather than individuals, so most people don't see the true cost of insurance. Hospitals get to charge insane amounts for certain procedures, since patients won't pay the entire bill, the insurance company will. And (upper-middle-class) patients are mostly happy, because healthcare feels cheap to them (since, again they never see the true cost they paid).
Which exact parties are extracting excess profits?
Are you claiming that profit margin percentage should always go down in a competitive market as revenue goes up? Do you have sufficient knowledge about the scalability and marginal costs of a business to be able to make that claim?
Also where you getting "trillions" of dollars of revenue from?
UHC - $300B, Anthem - $145B, CVS - $300B, Cigna - $177B, Humana - $86B, Molina - $29B, Centene - $133B, Kaiser - $90B.
Total is ~ $1.3T for the biggest managed care organizations. They get much smaller after that. The fact that all of these organizations are publicly traded with public financials and they all have many years of consistent 5% or less profit margins is very high quality evidence of a competitive market with not much juice left to squeeze.
Visit any health clinic, hospital, or doctor's office. If you count, you'll find that the office staff devoted to handling insurance rival those devoted to patient care. (It isn't strange for the former to outnumber the latter.) They're not just sending in claims. They're dealing with claims rejected for ever more specious reasons, figuring out alternative "codes" to forestall those rejections, verifying that patients have insurance, explaining to patients that the insurance they bought from daytime TV commercials doesn't actually cover anything, collecting old debts inherent to the "bill insurance first then send the patient a bill six months later" model, etc.
Obviously all of that is a giant waste that does nothing to make anyone healthier. But this is just the tip of the iceberg. With few exceptions, the costs of insured procedures are completely unknown at the time the procedures occur. It's no surprise that when consumers have no information whatsoever, the market doesn't properly allocate resources. (Sure, we can argue that healthcare shouldn't be provided via a market, but given that it is, that market should be somewhat functional.) Drug prices are also opaque, given the secret negotiations and kickbacks among drug marketers, insurers, healthcare executives, and regulators. The worst thing about USA healthcare, which causes most of the other problems, is the ferocious price inflation, and that is almost entirely caused by the way we use health insurance.
All of the things that insurers do, besides just paying, harm patients and make healthcare worse. They distort the market more than they extract rents from it. It's as if they have a great bonfire burning cash, and we should compliment them because they only shove 5% of the money in their pockets while shoveling the rest into the fire.
Making broken regulations to entrench large market players is the most patriotic of pastimes in America.
The problem was that some could not, so we introduced insurance.
At this point no one can afford it anymore without insurance. So our fix for one problem created a new problem.
And then there is healthcare, like diabetes, hypertension, stroke, obesity, heart disease, arthritis, old age, and end of life care.
The former is an insurable event, with low probability and relatively small costs.
The latter is inevitable and basically not insurable at any price that 95% of people can afford.
The question is really how much of society’s resources does society want to go towards those chronic and old age issues, because there can be almost infinite demand for more and more resources.
Government and private insurance raises prices.
Cash excludes poor people.
"Top 10 Countries Where Insulin is Most Expensive (2018 RAND Corporation)[1]:
United States — $98.70
Chile — $21.48
Mexico — $16.48
Japan — $14.40
Switzerland — $12.46
Canada — $12.00
Germany — $11.00
Korea — $10.30
Luxembourg — $10.15
Italy — $10.03Maybe government run healthcare is more expensive than (something) but your "both sides are bad" is missing how unbalanced the sides are.
"In 2016, the U.S. spent nearly twice as much on health care as other high-income countries, yet had poorer population health outcomes. [...] Using international data primarily from 2013 to 2016, the researchers compared the U.S. with 10 other high-income countries — the U.K., Canada, Germany, Australia, Japan, Sweden, France, Denmark, the Netherlands, and Switzerland — on approximately 100 metrics that underpin health care spending. The study confirmed that the U.S. has substantially higher spending, worse population health outcomes, and worse access to care than other wealthy countries. [...] Life expectancy in the U.S. was the lowest of all 11 countries in the study, at 78.8 years; [...] the proportion of the U.S. population with health insurance was 90 percent, lower than all the other countries, which ranged from 99 to 100 percent coverage.
For several commonly used brand-name pharmaceuticals, the U.S. had substantially higher prices than other countries, often double the next-highest price." - https://news.harvard.edu/gazette/story/2018/03/u-s-pays-more...
[1] https://worldpopulationreview.com/country-rankings/cost-of-i...
To be brutal about this: we in the U.S. demonstrably pay more per person that the rest of the "developed" world, and we get worse outcomes for it, and that is not even counting that we exclude a good portion of our population (which other countries do not).
The only place the U.S. excels is at the very top of healthcare, the part that 1% of our population will ever see. We pay the top doctors the top dollar, so they come here, where they charge uber-top-dollar. At one point a lot of this was going to fund new drugs and clinical methods, which quickly filtered down to help everyone. But at this point those filter-downs are few and far between, and it is simply going to those who have the most money, or are the most visible.
> we in the U.S. demonstrably pay more per person that the rest of the "developed" world
It's possible both of these can be true. Government ownership increases prices and we happen to be towards the worst end of the spectrum in terms of real overhead by such a system.
Perhaps the advent of insurance helped bring more advanced and therefor better medical care to the average person that would otherwise be unaffordable.
For example several attempts to privatize the VA failed because of the vast increase in costs.
Where I live for example, from a cost perspective I can't really shop around because there are no individual practices anymore. They (and the clincs and the hospitals) are all owned by the same vast medical congolmerate. It's completely anticompetitive, yet the FTC has not shown any concern AFAIK.
You're 100% confident in that assessment?
I'm not going to claim less regulation could help control prices. The typical certificate of need process seems like something that could go away without much problem (I find it unlikely anybody would invest in a new hospital or whatever other facility without being relatively confident there's a market). But, regulation on drugs and devices probably should remain.