The general walled garden existence of health care providers - the incredible disparity between list prices for procedures (the "chargemaster") and the cost to deliver those procedures including labour and parts - these are some entrenched business that lobby the government to establish a broken healthcare system, but it isn't everything!
You also need to look at PBMs that eek out a living as a middleman between pharma companies and insurers and survive by bulk offering pharmaceutical consumption in exchange for rebates while advocating for higher pre-insured prices to maximize the price difference between direct purchasing and their rebate reduced price.
You _also_ need to look at health insurers that operate in pretty much the same manner as PBMs but with everything that isn't a drug, highers list prices at hospitals coupled with lower negotiated rates for their patients is why a person with good insurance may pay 130$ for a 13k list price procedure, and the people with bad insurance are hit with the full cost.
Lastly the siloing of patients to specific care networks gives healthcare providers better control over how much that after insurance take-home is for themselves, if there are three hospitals within a few hours of you but two are out of network and the last one won't give you upfront information about their pricing then you have no freedom to choose efficiently.
Oh also, the pharma companies, they've gotten a bad rap recently for opiods. But it's a generally policy that drug reps that monetarily reward doctors for prescribing certain volumes of medication without any relation to patient needs, thus driving up the unnecessary usage of medication (and the cost to insurers, and the cut of PBMs) while also potentially causing further health issues from side effects of a drug the person didn't need in the first place.
Everything in this system is broken and it's basically just a carousel of terrible where each pillar is supporting the other ones because everyone is making so much damn money - and politicians are happy to force any state offerings to play by the same rules for a share of that cash for themselves.
In a sane system without the lobbying and corruption this cartel of players would be unsustainable because public interest would force politicians to cut down on their crap, but that ain't happening. And, while I think some intents of the law were decent, the actual effect of the ACA has been to cement the improper running of this market into law while forcing absolutely everyone into insurance - the ACA was a huge gift to insurers and it, and the private insurance and healthcare market that spawned it, need to be nationalized.
The existence of that state-run hospital and the illogical size of their bill is a result of a lot of the lobbying done to keep the private industry from being uncompetitive with publicly offered healthcare.
If better priced options are available people are going to stop playing in that private healthcare sandbox - it's part of the same reason why the house has been unable to legalize purchasing drugs abroad... that too would weaken the price fixing abilities of pharmaceutical manufacturers and PBMs - also maybe pharmacies, they tend to get squeezed pretty hard by PBMs though so only in the case where a pharmacy is being squeezed by its own PBM (as is the case of CVS) is the pharmacy really embroiled heavily in this mess as a loss leader.
> The existence of that state-run hospital and the illogical size of their bill is a result of a lot of the lobbying done to keep the private industry from being uncompetitive with publicly offered healthcare.
Do you have evidence of the Virginia legislature meddling with the hospital's charge master? I could certainly believe that, but in the absence of evidence I'm more inclined to think it's just the hospital administrators trying to extract every dollar they can out of patients. For some reason even non-profit and government entities often seem to have a disturbing emphasis on revenue enhancement.
I don't have any such evidence and I agree with you that it's quite possible that this particular hospital isn't being directly influenced - the fact that the market seems to be dictating that these prices are acceptable could in fact be the sole influence over the charge master - but it's my view that this pricing level would be impossible is surrounding private healthcare facilities had more reasonable prices.
This, and the number of bad actors involved with healthcare, is sort of the issue - whenever the PBMs are under attack they claim innocence and say it's the pharma manufacturers - similarly here the hospital did indeed act in a rational way in their pricing, but that way is only made rational by the broken national system - and if, while an aspirin at a hospital normally costs 100$, at this publicly funded hospital that aspirin cost you 3c[1] then there would probably be outcry by the private hospital that the public healthcare offering is unfairly undercutting prices in a manner that private organization couldn't compete with - you can see this happening right now with the wonderful debate on municipal internet.
1. Insert reasonable cost here, 3c seems much less stupid expensive to me, it's probably still like a 100% markup if buying in bulk but Amazon is willing to give me 100 pills of aspirin for $3.08
Also, at the risk of not getting that question answered, what does lobbying have to do with people being underinsured?