> the provider and the "insurance" company both continue to keep the actual prices obfuscated with those fictitious numbers and a whole bunch of "adjustments",

> the provider and the "insurance" company both continue to keep the actual prices obfuscated with those fictitious numbers and a whole bunch of "adjustments", rather than ever just plainly stating prices. That's the name of the game, not unique to USofA. Once you have majority/monopoly payer (be that private insurance or tax-supported state health fund) it becomes a game of cat and mouse. Health providers try to extract as much per case as possible, insurance providers try to cut per-case payment to the minimum. Inflating list prices on provider's end, establishing various per-item limits and per-case adjustments on payer's end are the low hanging fruit towards the goal. State insurance systems just have this less visible as the patient is usually not involved in the invoicing process, but nevertheless it is there. The sad reality is that there is very little to none incentive for list prices to remain low or reflective of actual cost.