I looked at the fees charge rates in the local area here they varied 300% between the local hospitals -- regionally within the state they varied (lowest to highest) 400% WTF?

It is all in the same locality -- I am not comparing New York City fees to Jackson, Mississippi fees. Maybe, Medicaid pays 20% of the fee charges, Medicare a bit more, private insurance negotiate rates that can vary a lot, 40% to 60% of the "asking price". And the real kicker is the least able to pay -- the uninsured get billed to top rates, then the majority of them don't pay or cannot pay and the government reimburses the hospital at the lowest rate (Medicaid rate).

So, what happens is that the insured subsidize many services with the hospitals jacking up the "asking price" resulting in higher insurance premiums.

Now, the insurance company's negotiated rates are subject to a policy owner's deductible -- 20% up to $2K - $10K?

Goes down like this: insurance company #1 negotiates $17,000 and insurance company #2 negotiates $28,000 for the same procedure at the same hospital that has a "asking price" of $44,000. You pay 20% of that negotiated "contract price" as your deductible!

I am not sure who is fucking who here but the first place to start controlling health care costs is a transparent, fairer and competitive marketplace price. That $44,000 procedure might get Medicare reimbursement at $9,000 with the balance charged off, and what can be recovered paid by the insurers of the private insured patient.

This is one reason the current insurance premiums are unreasonably costly in the USA. Next to be revealed are the insurance company's negotiated rates -- why does insurance company #1 negotiate $17,000 and insurance company #2 negotiate $28,000 for the same procedure at the same hospital? Are they just incompetent negotiators or is someone taking kick-backs?

This should be interesting as it develops ...

This would only matter to you if you have skin in the game, or want to, or are forced to get into the game.