I was talking to someone who cut off a couple of fingers. His bill was initially under $2,000 without insurance but when he told them he had insurance it went up to something like $9,000. His $200 ambulance ride went to $1,200.

Sadly having a profit motivated middle man increases costs for everyone.

That's just a version of "Hollywood Accounting". If he looked at the EOB he would have seen that the actual payout was $2,000 and $200. The rest would be charged off as something like "Adjustments" or "discount".

When my wife had her pacemaker replaced the hospital "total charges" was $15,900, "adjustments" was -$13,200. Insurance paid $2,200. Our amount was $360 (mostly the annual deductible).

Another time there was an unexpected 2 week hospital stay, total charges around $200,000. The net paid by insurance was about $60,000. Our amount was $1,200.

When we talked to the hospital coordinator on the 2nd day and I expressed fear about being hit by the whole thing, since we did not get pre-approval from the insurance company, she said, "Don't worry about it. If the insurance will not pay it, we will only bill you for what you would have had to pay if they DID cover it."
BTW, the insurance company (Humana) did cover it.

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If you think "a profit motivated middle man" is bad, take a close look at the Canada health system. M.A.I.D. (assisted suicide)
"In 2024, 5.1% of people in Canada who died received MAID."

"Medical System Savings: A 2020 estimate suggested that MAID could result in a net reduction in healthcare costs, with a projected $62 million in savings."