"...but we have to remember that doctors, and the pharma industry, operate within the free enterprise system, and can charge whatever they want and/or the market will bear."
No, that is not the case at all. There is no "free market. "
Since no one (of less than a several million net worth) can realistically pay for major medical costs, insurance is the way we do it.
Since insurance is the game, people don't see the costs, except for monthly premiums and minor copays. The doctors don't care what the price is since they are not billing the patient. they are billing the insurance which has already agreed what they will pay. The insurance company is the only limiter since they don't want to pay out too much, but they have to pay for "usual" care so whatever the doctors decide is "usual" is what insurance will pay.
A drug like Herceptin for breast cancer costs about $8,000 per month per patient. those are usually the sickest patients so it may only be a few months of treatment before they die. Herceptin lengthens life expectancy by 2 - 5 months on average. Some may live longer but those will pay 8K per month for a long time.
A free market implies that you can compare prices between vendors. That is not the case in healthcare because most people just buy insurance, not procedures. No one knows which procedures they will need. So then It depends on which of the many providers you will use for your care. Most limit your options. Even companies that provide health insurance for their employees limit what plans you can use. There is little free choice in actuality.
Unless you are uninsured, and then you are just screwed every which way because you are going to pay yourself into bankruptcy for anything major. Just an overnight ER stay will be $10 to $20K and that is if you don't need surgery.
Even for a specific procedure the system their is no free market. The system is primarily run by cartels of insurance companies. If you go to a hospital and ask about a price for a procedure they will not be able to tell you unless you tell them your insurance company. They negotiate different prices for every insurance company. There is no relation except volume. If you don't have insurance they will charge you "full" price, which is actually padded to include losses for those patients they treat who cannot pay, or for medicare funding that does not cover full cost.
Not only that, insurance does not cover everything so they cannot tell you a price because they don't know what they will actually do (they cannot account up front for all those extra tests and treatments that you may or may not need) and those extras will add to the price, which insurance may or may not cover.
the hospital has armies of billing clerks to figure all this out. How is an average person supposed to "shop around" for healthcare on their own?
Some of the discussion is kind of crazy. It seems like a lot of people think this is the 1930's where a person goes to the hospital with cancer and the doctor says , "gee, too bad, you have cancer" and you go home to die in peace. Nowadays we are spending hundreds of thousands to treat people and often curing them. That's great, but lets not pretend it is cheap to do. Whether the prices are realistic or not is up for discussion, but it is not the 1930's.
Another example - when kidney dialysis came in decades ago they thought there would be at most a few thousand people using dialysis so they decided to cover the full cost. now we have millions on dialysis and are still covering the full cost and of course the total cost has gone up exponentially with no end in sight (diabetes is the primary cause).
Many on dialysis end up with kidney transplants, but even there are people getting multiple transplants because they end up with the same disease. it's a crazy cycle. Only prevention at a young age will help break that cycle.