The hidden fee costing doctors millions every year

- Doctors/providers (emphasis on specialists vs preventive family care)

- Drug/Device companies

- Insurance companies

- Trial lawyers / ambulance chasers (the boogeymen)

Each of these has an associated cartel/monopoly/trust/guild restricting supply and increasing prices.

Providers have the AMA and control over accreditation of schools producing doctors. It defends large swathes of medical care as requiring a doctor when it isn't necessary, and forbids expert systems and other things that would devalue doctors.

Drug/Device companies use patents/FDA and increasingly are doing outright monopoly behavior like buying up production to skyrocket insulin and epipens that should be commodity priced.

Insurance companies use regional monopolies, network lock-in pricing (in-network vs out-of-network), exclusive arrangements with large employers, and rent extraction thereof.

Trial lawyers have the bar association and the entire judicial branch protecting their interests and abilities to sue.

Anyway, this is interesting because it is a shadow cost between the insurance trust and providers trust, but of course it will bubble up to more cost inefficiency.