It's not that complex.   The love of money remains the root of all evil.      Medical costs are what they are because they can be.   There is no consumer choice in health care.   In a small isolated market like Alaska, you have generally one choice of provider (i.e find a cardiologist not affiliated with the Alaska Heart Institute).     They can charge whatever because you have no choice but to pay, or suffer.     Single payer with cost controls is the only way to eliminate profit and therefore greed in the system.   Medical care should not be a for profit enterprise as the rest of the developed world has already figured out.    Until we change the fundamental way we deliver health care, we will continued to get squeezed for every dime we have to obtain it.