Warning: Rant incoming.

You're completely right. The entire thing is a bit more complicated. (If you think I disagree with you, I don't. Keep reading.) If I run a doctor's office and I'm the only doctor there, I need to lease the property, get the equipment, hire at least a receptionist and a medical assistant, have some way to replace them on short notice if one or both decide not to show up, pay the utilities, and pay for insurance. That's a minimum. Not included in that is all the bullshit put on the doctor personally like malpractice insurance, licensing fees, fees for professional organizations(*) that he may not even want to be a part of, certification fees(**), and so on. So like any business, there is a hidden overhead to the entire thing, and with medicine a lot of it isn't what you'd necessarily expect, because the doctor, who is the business really, has a load of crap thrown on him too.

So then someone comes in. If they want to pay cash, great. The doctor cuts them some kind of deal (if he's decent). This is because if you come in and claim insurance of any kind, including Medicaid or Medicare, there's a large hidden cost in the background there too. So now the doctor has to either hire his own billers, or more likely contract out to some agency that is going to charge a monthly fee and take a certain percentage of whatever he gets back. If the doctor charges $100 for something to an insurance company, there are a few things that go on. He may get $100, but could he have collected $200 instead? They may only pay some percentage of what he charges up to some maximum (probably most common) so he only gets $60, where if he charged $500 he might get $200. This sick game goes on and on.

So in a lot of ways, it's like taking your car into the mechanic. The mechanic has to diagnose the car, which isn't free. Then he presents you with an estimate. You take the estimate and he works on the car. It takes $x in parts. But most of the cost is $y in labor. During the entire process, something else comes up and he has to address another problem so he calls you. You agree to pay $z extra for extra parts and labor. There's always the possibility that there's another problem that didn't present itself and comes up later. People understand this (mostly) with cars, but with healthcare they sue the doctor five years later because they came in for an ingrown toenail and the next week were diagnosed with type II diabetes.

The entire healthcare system is broken. We all know that. I've had to argue with insurance companies about all sorts of stuff. But you still get the person who comes in and says that they want some random test that doesn't affect their outcome at all. When you tell them that it isn't medically indicated and the insurance won't cover it, they inevitably say "Oh, I'll pay for it." The doctor explains again that it isn't necessary, but they start looking like they'd be litigious. So the doctor orders the test and covers himself. Goes great until they get the bill from the imaging company. Then they're slapped with a $4000 bill for a completely unnecessary MRI that it's documented that they demanded despite medical advice to the contrary, and they start spewing complaints which are warrantless, etc. (That's where the doctor's malpractice comes in again, to defend against stupid complaints. You're going to get a lawyer every time, who is going to fleece the insurance company for no less than $8000 to handle it. This raises everyone's insurance rates... wash, rinse, repeat.)

If the average person knew just how screwed up the American healthcare system was, they would riot. That's because it isn't just the normal level of screwness. It's epic. It's a pyramid. At the bottom, of course, you have the patients. Then you have the "providers" (doctors, nurse practitioners, physician assistants). Then you have the insurance companies, etc., and at the top the lawyers.

I've seen it on both sides. Recently I had an accident in my house and fell. I briefly lost consciousness. I wound up