But they are charging that other customer $500 for that $100 procedure. If they charged him $110, it's much more likely that he could pay. And it's not like insurance companies are easy to deal with, optimizing payouts means hospitals hire entire coding departments and they still sometimes see long delays untill payment for complicated procedures.

And unlike, say, choosing between buying a $250k Lamborghini vs a $20k Toyota, the patient has to choose the $250k bypass surgery or he'll die. Which is why this can't fairly be judged purely in business terms, customers have little choice in whether or not they purchase healthcare services.