The biggest cost driver is complexity, not profiteering.
The Japanese system is not terribly different from ours - it still depends on private employer-provided health insurance. But per capita costs are less than half the US cost, with higher utilization and far better outcomes. The key difference is that Japan has strict national-level price controls. The price of identical products and procedures is identical in every facility. This eliminates both complexity and negotiation between insurance and providers. A government board carefully tracks costs for profiteering and makes adjustments.
Do that, and you get rid of the whole "in network/out of network" nonsense of the American system.
The Japanese system is not terribly different from ours - it still depends on private employer-provided health insurance. But per capita costs are less than half the US cost, with higher utilization and far better outcomes. The key difference is that Japan has strict national-level price controls. The price of identical products and procedures is identical in every facility. This eliminates both complexity and negotiation between insurance and providers. A government board carefully tracks costs for profiteering and makes adjustments.
Do that, and you get rid of the whole "in network/out of network" nonsense of the American system.