The buyer and sellers are frequently wrong. The buyer isn’t the patient, it’s the employer. The insurer is either charging a premium for risk or servicing work for a self-pay employer.

The biggest buyer is the Federal government and by law they are required to get the best deal, the government also restricts the supply of providers. It’s not a capitalist system at all. It’s a weird hybrid command economy with a consolidating cartel of providers and administrators.