If they were actually doing that, great! Unfortunately, as TFA clearly demonstrates, they are doing a crappy job of this sort of negotiations, because their pro

If they were actually doing that, great! Unfortunately, as TFA clearly demonstrates, they are doing a crappy job of this sort of negotiations, because their profits are generally a % of total medical spend: more medical spend, more gross profit! So why would you want to limit it? Hence the fact that, as the article documents, people routinely are getting charged more with insurance than the cash price they would be charged with no insurance. (If you tried to pay the cash price then it doesn't count against your deductible, so it would be rare to do that.) There was a serious effort by health insurance to restrain medical spending with the HMO/limited medical network era of the early to mid-1990's, which led to a massive pushback from people who hated having to change doctors all the time. In large part because they were so widely hated that no one has tried to revive them (modern HMO's are not nearly as limited in networks) they also were the one period in the last 40 years when medical cost growth was held down.