>If this is somewhat the case, I would sort of expect insurance companies to be lobbying for the system to be changed, and they seem to have the capital to actually make a difference in that "fight"?
Insurance companies have the opposite incentive. Their profit is, to simplify, a percentage cut of the total amount spent on medical care. If the cost of medical care goes up, they raise rates and the market pays for it (what else is it going to do?) the poor or underemployed or non-traditionally-employed suffer.
They will fight a small amount to keep costs low, but only in a relative sense in that they want to beat their competitors or not pay for one off extremely expensive things.
The middleman to which you give a fixed percentage isn't really all that motivated to get you your best price.
Insurance companies have the opposite incentive. Their profit is, to simplify, a percentage cut of the total amount spent on medical care. If the cost of medical care goes up, they raise rates and the market pays for it (what else is it going to do?) the poor or underemployed or non-traditionally-employed suffer.
They will fight a small amount to keep costs low, but only in a relative sense in that they want to beat their competitors or not pay for one off extremely expensive things.
The middleman to which you give a fixed percentage isn't really all that motivated to get you your best price.