And this is supposed to be an answer?

1) In many cases you are paying that high "markup" for the handling rather than the product.

2) Hospitals are typically not making much money. Available 24/365 costs. Deadbeats cost.

3) Yes, most people don't pay much healthcare in any given year. But you don't know what year they are going to.

4) I like the idea of it as a tax--but in the real world this always ends up with the fox guarding the henhouse. Because most people don't need much care in a given year it's easy to satisfy the majority of the population with poor quality care. The ones that see the failure aren't enough to change the outcome of the ballot box.