This isn't universal. Several times I've gone to "urgent care" clinics for e.g. persistent illness without insurance, and my bill showed a 50% discount for paying cash. Perhaps if I had had the right insurance the effective discount would have been even higher, but it makes sense that cash is worth more to a provider than an insurance claim that might be disputed or delayed. This is kind of the "sweet spot" for cash, though. For more expensive procedures even a 50% discount wouldn't make it easy to pay cash. Anyway, it's clear that a portion of the high prices for care in USA are specifically for dealing with insurance companies, both for "negotiating room" and to compensate for the hours that must be spent every day dealing with insurance companies.