You left out politicians. As far as companies like this are concerned, they are functioning within the limits of the law.

If the by-far dominant ethos of the upper and ruling classes is "greed is good, more is better" capitalism, then no actual collusion is needed for millions of self-serving individuals to send healthcare costs spiraling ever-upward through their own "from each as much as his ability to pay, to each according to his greed" actions.

If it is not collusion, it is corruption.

But it is still hard for me to believe that these companies are all okay with robbing each other, just because the margins make sense somewhere else down the line.

6% of healthcare dollars go to insurance. Maybe that’s too much, but it doesn’t seem like a major factor?

That’s the direct cost, a doctor talking to an insurance company is extremely expensive and not covered in that 6%.

> I’ve never seen a charge for talking to ins co.

You don’t see the cost of the electricity on your bill either, but it’s going to be passed on.

Doctors can’t directly bill anyone for this time so they simply bump up other charges to compensate, the same way they cover rent or the office phone bill.

Insurance companies should be driving DOWN the cost for care. It's not possible for us to have the most expensive healthcare in the world and for them to still be profitable, unless there is corruption.

There are more people in billing than there are hospital beds, in the US.

There's a large system set up to interface with insurance. It adds massive process overhead.