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The system is loaded with layer apon layer of bureaucracy. And each layer has to take their cut.
Imagine the cost of groceries if no store posted pricing in advance. Imagine the only way you could know your bill was after you check out. Imagine that there was no return policy and once you checked out you had to pay the bill. Imagine how little concern of the overall cost if you had a food insurance policy that picked up most of the tab.
Hospitals know to the Q tip the average cost of procedures.
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