[chimeracoder]

> ver many decades, the insurance companies have negotiated payments much less than the quoted payment. In turn, the healthcare providers raise their rates in order to make sure they can still make money even with the discount they give insurance. When the time comes for the insurance companies to renegotiate, the same thing happens, and the healthcare providers raise their rates. This works fine for those of us who have insurance, but for non insured individuals, they have to pay the "actual" rate - which has been inflated because of the insurance company discount! This has been going on for many decades

This is close to correct, but a subtle correction:

Medicare and Medicaid set their reimbursement rates by fiat, and providers have essentially no ability to negotiate those. Except in critical access areas, Medicare actually reimburses much less than the marginal costs of care for its patients (7% in the aggregate). As a result, providers present very large bills to everyone else (privately insured and uninsured patients) to make up for this loss - you can't stay in business if you're literally making a loss on every patient! Uninsured patients see the large bill and assume they have to pay the entire amount (they don't!), and private insurers end up negotiating that down to some multiple of what Medicare pays.

A typical insurer will negotiate an agreement like, "we'll pay 350% of what Medicare pays for this category of services".