One issue with describing figures like 600k is that I think the medical industry has a lot of funny money running around. The doctor somewhat arbitrarily charges 10k to the insurance company, insurance disputes, the doctor hires a lawyer who takes 30% of the negotiated outcome, and negotiation finally ends up at $2k.

The patient sees a $10k bill, pays a $300 deductible, and only $2k ever actually materializes in the exchange between doctor/insurance. And afaict, this is the expected operation.

Of course, when you're uninsured, the numbers stop making any sense, because they fail to go through the convoluted process that reduces it. You just get the $10k bill and thats the end of story. But for the insured, a $10k bill is not $10k exchanged.

Yeah, some of the explanation of benefits I've received are insane. Insurance is apparently able to negotiate ~50% bill reductions for multi 10K bills.

Dealing with Indians, the normal bargaining tactic is apparently start with like 300%/10% of the expected, and end up at 110%/90% as anywhere else would. From America, starting is 120%/80% or so. Totally confounding when you first start negotiations, because they're offering these absurd numbers as if its normal..

I think the same culture exists with doctors/insurance. It's not that they're skilled enough or have enough power to negotiate down 50%... doctors are putting numbers up expecting to be reduced to 50%.

And then us poor saps get slapped with these absurd numbers and thank the gods we had insurance... but no one involved ever really expected to pay that number. And ofc, without insurance, you're like an american trying to shop in india -- no idea how to play the game, trying to negotiate in the american fashion with 120%/80% when the other guy started with 300%, and don't have the information to realize that initial $20 offer negotiated down to $18 isn't even close to what an indian would have managed (probably $5).

And its not like he's going to correct you when you fail to negotiate properly.