responsibilities of each of these parties, how much they should charge, and who should pay what?:

(1) Bionic arm manufacturer

(2) Surgeons who install the arm

(3) Hospital/clinic where the surgeon works

(4) Employer who chooses the specific insurance plan (and may be self-insured)

(5) Insurance company who administers the insurance plan and reviews claims

#5 seems to take the most heat (especially lately), but are they really the main culprit for why costs are so high? It seems like they have an incentive to keep health care costs low (unlike #1-3 on my list).