Big problem with much of health care analysis is we count redistribution wrong. The government giving a poor person $10,000 for a surgery that they let hospitals overcharge $5,000 for is not a $10,000 transfer to poor people. It is $5,000 to poor person, $5,000 to rich people.
The redistribution impact of say the ACA looks much worse when using a more realistic metric. Letting someone overcharge a person, when the government is subsidizing coverage, should be correctly seen as transfer to well off doctors and hospitals.
For example the government capping out of network charges at 125% Medicare rate is technically non-budget but it would be a very large net transfer redistribution from mostly rich providers to middle class people.
Nothing highlights this more than Medicaid expansion and ACA subsidize. Technically people making just over twice the poverty rate are getting more money from the government than people in Medicaid expansion but Medicaid people have much better coverage.
We see same problem at the micro level. You have for example hospitals or drug makers claiming they say gave $1 million in charity services but they totally inflated the price of their services when in reality they providers services that would cost just $100,000 in say France.
