> The amount of money spent on medical billing is just obscene. It isn't "profit" for anyone, but it's vast inefficiency.

Which is the thing caused by low deductible plans. If that sort of paperwork was only necessary in cases where you're already paying for $10,000+ in medical services, the fixed overhead isn't that significant. But with low deductible plans you pay it for every little thing that ought to cost $50, and then the $50 thing costs $550 because even walking in the door requires $500 worth of paperwork.

How much more efficient would it be if you just walked in with $50 in cash in most cases, which you can take out of the thousands a year you'd save in insurance premiums?

Extreme inefficiency. Extreme amounts of money spent simply on accounting and legal teams to keep track of all the plans, in companies which often have at least a dozen different plans per state. And every doctors' office and hospital and urgent care must hire or contract these services. Before beginning to serve a patient they and/or the patient must do paperwork to look up in-network specifics and insurance coverage terms.

It really is obscene and totally a waste, and it doesn't have to be this way. The notion that the free market does things more efficiently isn't always true, particularly in captive-market situations like healthcare, particularly in purely middleman industries like insurance which are actually incentivized to poorly allocate money to the alleged business purpose (covering medical services for people) because it increases their own profit margins.