Here is a good story from the Wall Street Journal that I found in my search for good information on who pays the "rack rate" or "list price" for health care.
I agree that it is bothersome that some of the most needy end up paying the highest prices for health care.
But at the same time, there are some good reasons for those price differences and some lessons to be learned.
How many of us ask when we go to the doctor what the price of the service will be (and how many doctors even know)? Why are we willing to accept such ignorance of prices from docs and hospitals when we will haggle to the final penny with a car dealer or a bank on a mortgage? This is just one example of the inconsistencies in people's behavior when it comes to health care vs. other products and services. Another one is that many people think regular exams and preventive maintenance should obviously be covered by insurance. I bet I could find people who would argue that, on their way to the car dealership to pay hundreds of dollars for their 50,000 mile checkup on their three year old Chevy. We accept that we have to maintain our cars, houses, and other property, but not our own bodies? Go figure.
At least larger insurance plans do some negotiating for us. It is too bad that not everybody gets the benefit of those negotiated rates -- if self employed people buy individual insurance plans and then have to pay full list prices. But again, if we take away the incentives for anyone to negotiate, what will that do to the pricing power of the suppliers and to the overall level of prices? I predict we would see even higher prices.
I believe it is also true that the great price differences we observe today in health care (list price vs. negotiated health plan rates) began when Medicare got into the market. Just an observation...