You can figure try to figure out the "why" for specific cases but it's tedious work and comes down to subjective opinions that can't be generalized to other cases. The theoretical worth of the shadowy middlemen (whether they gov't or insurance companies) and where the blame lies can be debated. All these arguments rely upon theoretical simplifications of very complex systems--meaning they are almost impossible to model.

What's more important is the "what" as in what are our alternatives. Luckily, we have tons of empirical data from other countries and they all tell the same story: America pays more money, with poorer results.

So why not just copy the models of other countries?

After 15min ER due to a strained wrist the bill was $4100 dollars. We demanded detailed itemized bills and send letters to the doctor (billed separately) and the hospital. The doctor dropped his bill from ridiculous $900 dollars (for saying everything was alright and taking 5 mins to open a tiff file on his computer) to $200 after our complaint. His bill and the hospital had up-coded our visit and tried to hide the costs of their ill-managed hospital by billing a piece of cloth (made in Guatemala) with $500, the price of an iPad.

Really? Nobody ever asks? Whenever the subject of American hospitalization comes up, the question of why the bills are so insanely high is pretty much the only question people ask!