In some instances, doctors in private practices have told me that taking Medicare or Medicaid means making less than minimum wage for certain procedures because the rates are fixed at such low values. In other cases, ER and intensive care units make nothing because they cannot legally turn anyone away for not being able to pay.

All of that has to be made up somewhere, and bilking insurance companies when they can are how they stay afloat.

Big companies can take the hit on high insurance rates. Drug makers live in boom and bust cycles (drugs are either fabulous money makers or bottomless pits that suck money from research, to testing, to the famously expensive FDA approval process).

The people hurt the worst are the small business employees and owners, the self employed, and the part time workers who can't afford to have the hospital come after them.