Check out how Californians get their healthcare here:

https://www.chcf.org/wp-content/uploads/2024/10/HealthInsure...

Medicare and Medical are not going to see a bill ever (if the people I know on them are anything to go by), and that's almost 40% of the population. A huge majority of people on employer plans are in the same situation, so thats some fraction of the 47%. For example, nearly a quarter of Californians are covered by Kaiser. It's not some super rare privilege reserved for those making >$500k.

No the fee for service system results in bills. It's the quarter on Kaiser that don't see bills.

I never see bills from my employer based healthcare, and it's not anything super fancy, and it's not Kaiser, just BC/BS. I had a surgery that billed my insurance in the tens of thousands of dollars and I never saw a bill. My spouse sees bills but it's because she has her physician order tests that are a bit outside well established medicine that would never be covered by NHS in the UK or Health Canada.

My relatives on Medical never see bills.

It's not just Kaiser.

Medicare patients get bills. There are deductibles and 20% co-insurance on most services. Inpatient care has a hard limit on number of days.

https://www.medicare.gov/basics/costs/medicare-costs