If the price is over the maximum deductible for the patient, insurance companies are interested in more expensive things. This gives the insurance company latit

If the price is over the maximum deductible for the patient, insurance companies are interested in more expensive things. This gives the insurance company latitude to increase costs. Since there's a legal limit on profit margins, increasing costs will let them increase revenue elsewhere...earning 8% on $2000 is more interesting than 8% on $1000. Doctors don't care about the price because they're not paying. You don't care about the price because it's over your deductible. Insurers don't care because they have latitude to raise prices every year. manufacturers don't care because the decision makers don't care. The French system has a "base price" that they will reinburse for medical supplies/tools. Doctors can go over, but then it's out of pocket for the patient.