@hawkeye10,
In a way, it's a con. The hospital reports a total bill, but is actually paid a negotiated amount by the insurance company. I once had a total hospital bill of over 15,000. Copay was 1,000 and the insurance company actually paid something over 7,000. The balance was discounted by the hospital.
If you are uninsured, you get stuck for the whole deal. You pay, or hounded into bankruptcy - at which point the hospital gets nothing. I suppose the operating theory is that they have to over charge to make up for the people they force into bankruptcy and their medicare patients.
The total ambulance charge was 3,500, which amounted to a grand a mile. Copay was under 200, and the insurance company paid not much more. It looked like they seriously overcharge so they can make a real swell discount - but not to everyone.