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It is a scam pulled by insurance companies.
Let say there is a doctor that charges $100 for a visit. They come too then and say "we have large network, we can provide many patients for you, but we will pay 20% of your price".
The doctor still needs to get $100, because also needs to pay the staff and other expenses, so s/he raises their price to $500.
Now someone without insurance comes. The doctor doesn't need $500, and is ok charging just $100. But if s/he does the insurance might sure them that the doctor lied to them and they only supposed to pay $20. So they are forced to charge $500.
In summary, that $500 is never paid by anyone unless they don't have insurance.
You can check how much discount insurance pays by looking for "adjustment" column on your bill.
They purposefully use that name and posting the difference instead of price to obfuscate this.
What insurance is paying is the billed amount minus adjustment minus your copay and deductible.
There are other things contributing to high prices, but this is the biggest one IMO. If we didn't have insurance meddling with the prices, the prices would be much lower. Still high, but at least something someone could be able to pay.
The markups on labs are even more ridiculous, unless it is some highly specialized test they are actually cheap to the point that some insurances don't even require copays.
No, it’s cowardice on the part of the American people who refuse to throw a punch
It's hard to call it cowardice, when most people are not even aware of the scam.