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Well, the conservative argument, which probably has some merit, is that patients are disconnected from the economics and thus don't play their role in the invisible hand theory.

But I still don't see why insurance companies with a little help from patients aren't able to reel in costs.

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Insurance companies do reel in costs. They often pay far below the "public" rates for services. However, they don't pass that difference on to consumers. They keep it for themselves as profit.

Then why don't employers/patients influence costs down?

Because, while not bosom buddies, the medical professionals and insurance companies are better at working together to influence costs up?

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