All of the state options pay only ~10% of what they are billed no matter how large the bill (there is also usually a cap). This forces hospitals to charge exorbitant prices. Private insurance options pay larger percentages: 12 - 50%. People without insurance usually will pay either 100% or 0%, with some people negotiating in between.
Honestly, the easiest way to fix it is to get rid of Medicare, Medicaid, and social security or force everyone to pay 100% as opposed to negotiating lower rates.
Fyi I worked in a medical billing office for 5 years. We did payment processing for about 30% of all hospitals on the east coast and Midwest
Bullshit. This isn't an easy problem, and you're casually dismissing systems that support millions of people.