"All of the above."

I have experience with the healthcare system, though not in the way you seem to be referring to—like with pharmaceutical companies and so on. My experience was related to surgical procedures, and both in private and public settings, the cost of medical supplies is absurdly high—not due to scarcity. Scarcity plays a role, yes—there are only a few players—but one of the main reasons for the high costs is the involvement of salespeople we often call “doctors.” They get their commission.