People think it's because those who can't afford it get care anyway, and we all pay for that. But that's not really why. It's a factor now, but that's not how it got this way.

It got this way because the insurance industry started demanding huge discounts from health care providers, in exchange for the massive volume of business they could flood that way. To protect their (already significant) profits, providers made up completely BS prices for things, so they could discount off that for insurance companies.

Unfortunately that means uninsured people are paying $200 for a $1 IV bag, or $37 for a single tylenol. And because of this crazy fee-inflation, the insurance company, even at its discount, pays way more than things are worth, and makes up for it in our premiums.

Once THAT happened, people couldn't afford it and started getting "free" (but I'd rather call it "systemically subsidized") care in the ER. Providers have used that to justify their prices, but that's a symptom, not a cause.