I won't argue with that. Employer-provided healthcare is one of the key obfuscators of the cost of healthcare as far as patients are concerned.

It also has secondary effects in employment markets:

* employers should not be encouraged to replace full-time workers with part-time workers because of health insurance costs

* employees shouldn't be making decisions about careers and jobs based on what health insurance costs will be

* the actual compensation levels between jobs is harder to evaluate since health benefits can be a huge chunk of compensation these days

There's a simple reason they charge whatever they want and generally can't even be bothered to disclose those prices ahead of time: because they can.

To critics of the ACA, the relevant question is, who or what is in an effective position to put downward pricing pressure on hospitals? Because to date, it has clearly not been individuals or insurance companies.

Single-payer systems have a track record for being much better at putting downward pressure on pricing. Not only can they secure drug discounts of ~50% due to their ability to bargain as a bloc against much smaller insurance companies in the US, but they lack perverse incentives to allow costs to rise. Insurance companies don't care about reducing costs, only reducing costs relative to competitors. Since their "cut" is a fraction of overall expenditures, they're quite happy to see costs rise, as long as they rise in tandem for their competitors.

Nobody who is familiar with the market is surprised that single-payer systems are so much cheaper.

Health Care costs by country: http://en.wikipedia.org/wiki/List_of_countries_by_total_heal...

Scholarly Analysis: http://www.pnhp.org/facts/single-payer-resources

[state health insurance]

> they lack perverse incentives to allow costs to rise

But, of course, they also lack incentive to actually provide all that much care, so long as those who are inconvenienced are politically unimportant (e.g. disabled newborns), and they have plenty of incentive to provide more care for the politically connected.

Theoretically, you're right.

In practice, we can just look at existing single payer systems and see how they're doing. Would you rather be a poor parent of a disabled child in the US or the UK?

The person best in the position to apply pricing pressure is the person paying the bills. Since individuals do not pay the bills, of course they haven't been put pricing pressure on hospitals.

The ACA pretty much doubles down on employer-provided health insurance that covers many routine costs, which doesn't address that issue.