I think you are missing some things.  Check ups are required before prescribing BC pills because they come with health risks that need to be monitored.  You ABSOLUTELY DO NOT KNOW WHAT CHILDBIRTH will cost.  Encouraging preventive screening saves lives and money.  The one thing I do think you are correct about is the high cost of the middle man.  When I had what appeared to be a stroke, I was conscious when I got my first ambulance ride (I'm in my late 60s and still working) and before I got in that rig I asked them (as best I could) if they took my insurance and were in network.  I asked the hospital, and the ER staff the same thing. In a prior stay, I had a Dr. visit me while I was in hospital, frankly I thought she was in training or something.  Never asked if she was in network.  I paid her three times what I paid a renowned cardiologist for her to come in and ask the exact same questions and give the exact same advise as the cardiologist, who also did a heart cath.