Many of the industry actors make bank based on spread, which incentivizes lack of downward pressure on prices in order to get allocated bigger chunks of money to manage as float. This increases earning in the event your risk pool is on the lighter side, and ensures that all actors material to price point fixation converge on price increases.

Medicare/Medicaid don't factor into the price point equation, because they aren't allowed to negotiate as a private market actor, and are considered by most who got into the U.S. medical industrial complex as a price of doing business to cash in on the fundamentally dysfunctional market.

Until you can get a straight answer out of insurers/hospitals/medical practices how much something will cost ahead of time,you won't get sane downward price pressure.

There's also the F'd Medical Education Complex issue and cartel as well, but that's another issue.

Full disclosure: Working somewhere that's trying to remedy at least a part of this dysfunction.