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the issue is funding... it doesn't matter if the hospital is run as a non-profit, as long as they are funded by insurance claims then the incentive is to do more expensive treatment... paying for more equipment, doctors etc

publicly-funded health care has the opposite problem - constant pressure to reduce the budget

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Does the insurance company have an incentive to pay as much as possible?

IIRC, the ACA has stipulation that 80% of premiums must be spent on medical services, so...a larger spend -> increased premiums -> a larger 20% piece of pie they can keep.

That's true, the minimum MLR creates a distorsion to the incentives.

[Gross oversimplification] Nope - insurers are incentivized to pay as little as they can get away with. Which leads to healthcare providers being incentivized to bill the insurers as much as they can get away with. They'll meet somewhere in the middle.

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