We're talking about how much the hospital has to pay its suppliers
Except suppliers can engage in their own fiat prices, as the OP demonstrates.
But your narrative does show the basic situation - where you have an elaborate digraph of buyers and sellers, most of which have a more or less monopolistic position. These monopolistic suppliers initially/formally set their prices based on "what they could possibly imagine getting", expecting regulators/down-stream-buyer to be the ones who will push things back into sanity (or not).
American health care, of course, has bounced from regulatory regime to another, with all of the players having to adjust. And moreover, all the players are now adept at adjusting, able to switch gears to leverage whatever ad-hoc cost reductions might go with any new system (cautious enough to lay-low when the new system comes since they know the politicians need to point to gains but will move on - see the way Obamacare worker great for two years, etc, etc).
And with all the bouncing, the situation has gotten only broadly more catastrophic. Health care was ~18% of GDP a year or two ago and no doubt is higher still.
Not only does health care have a problem but the four or eight cycle of ad-hoc fixes to health care has itself broken. Which might relate to the general breakdown of the countries political system, and so-on. I assume when (part of) Rome fell apart, no had seen an empire disintegrate on quite those terms (where a lot of civilization still remained on higher terms than Rome's neighbors). Perhaps our descendants will look back on this era in similar terms.
> Except suppliers can engage in their own fiat prices, as the OP demonstrates.
Those aren't fiat prices by any stretch. Aside from the fact that there is a competitive market of providers, patients don't have the obligation to pay the entire billed price (a key point which this article does not mention). That's neither a monopsony nor a monopoly.
Medicare, on the other hand, is a legal monopsony over its patient population and does set its prices by fiat. (There is no competitive market; patients can opt to receive their Medicare benefits privately, but they cannot opt out of Original Medicare entirely. Similarly, most providers cannot legally opt out of accepting Medicare, in practice).
Except suppliers can engage in their own fiat prices, as the OP demonstrates.
But your narrative does show the basic situation - where you have an elaborate digraph of buyers and sellers, most of which have a more or less monopolistic position. These monopolistic suppliers initially/formally set their prices based on "what they could possibly imagine getting", expecting regulators/down-stream-buyer to be the ones who will push things back into sanity (or not).
American health care, of course, has bounced from regulatory regime to another, with all of the players having to adjust. And moreover, all the players are now adept at adjusting, able to switch gears to leverage whatever ad-hoc cost reductions might go with any new system (cautious enough to lay-low when the new system comes since they know the politicians need to point to gains but will move on - see the way Obamacare worker great for two years, etc, etc).
And with all the bouncing, the situation has gotten only broadly more catastrophic. Health care was ~18% of GDP a year or two ago and no doubt is higher still.
Not only does health care have a problem but the four or eight cycle of ad-hoc fixes to health care has itself broken. Which might relate to the general breakdown of the countries political system, and so-on. I assume when (part of) Rome fell apart, no had seen an empire disintegrate on quite those terms (where a lot of civilization still remained on higher terms than Rome's neighbors). Perhaps our descendants will look back on this era in similar terms.