It’s the doctors.
Insurance company profit margins are capped by law and if anything their incentives are to pay the hospitals less.
US physician salaries are astronomical compared to anywhere else in the world.
Profit margins are capped by percentage. That creates the perverse intensive for insurance companies to pursue ever increasing costs in order to increase profits.
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Profit margins are capped by percentage. That creates the perverse intensive for insurance companies to pursue ever increasing costs in order to increase profits.