So, the whole problem with US healthcare is the malpractice insurance cost, but not the fact that bills are often padded with another few 0s if you're uninsured, and then reduced by 80% if you prove that you have no money left to pay for them? The cost of healthcare in this country is pseudo-randomly generated, and requires a pretty large accounting department in each hospital just to keep track of what money they may, or may not, receive in payment for a fairly simple medical procedure.
Malpractice insurance expense is easy to track in comparison to the randomness of medical bill payments.
I've worked on software that processes medicare forms. There's a ton of bureaucratic paperwork involved in even the simplest of procedures for medicare patients. Not sure on this point, but at one time, you had to print out the forms, and couldn't just send them electronically.