The difficulty is that "cost" has a layer of abstraction that you may not be considering. There are three acts in care. Act 1, you receive treatment and the ho

The difficulty is that "cost" has a layer of abstraction that you may not be considering. There are three acts in care. Act 1, you receive treatment and the hospital pays the nurses, doctors, and capital equipment. Act 2, the admin submits a claim and receives a quote from the insurer. Act 3, the insurer pays the admin. One of the reasons why a certain treatment plan is negotiated at 20x Medicare is that, 50% of the time, the private insurer rejects the claim (correctly or incorrectly), and the hospital group needs to maintain payroll for an admin whose entire job is to contest the rejection and win the ultimately agreed-upon rate. As you might guess, a large but difficult-to-quantify proportion of the quoted cost is this song and dance in Act 2. In Medicare, the distribution of Act 2's length is more predictable and smaller. Nobody addresses this elephant in the room, because it makes private insurers and hospital groups look bad, but it's where a lot of ballooning "costs" can be explained away.