The Insanity of Third-party Payment for Medical Services

I recently got billed from a local lab for a PSA test for $90+. I had the test done in August since I was getting blood drawn for other blood work. Medicare disapproved it because it was a month early (usually get it around my birthday in September). My wife said I should have known better. So I forgot to say "Mother, may I" and got my hand slapped.
The Medicare reimbursment for this test (i,e, what the lab would ha...ve gotten if I had done it in September) is ~ $25. Having run a little office lab for a few years when we had a 4 doctor group, I can assure everyone that one can make a profit with Medicare reimbursement, even with a little office lab running very part time.
Let me say that I don't consider the lab to be the culprit here. Like every other medical provider their fees are set by insurance reimbursement rather than their cost of doing business and their competition. (This particular lab provides a substantial screening lab package for uninsured patients for a very reasonable price and we send our free clinic patients there to take advantage of it.)
The fee is set to capture the highest insurer reimbursement. The overwhelming majority of their customers are insured and are concerned only about their co-pays and deductables, so the only ones who are discomfited are the uninsured or the bumblers like myself.
There's tremendous more to say about the insanity of our third party payment system in medical care but I'd like to keep it short. Let me just make the point that, if the standard way to pay for this test was directly out of pocket, the price to the consumer would be much, much lower than the Medicare reimbursement and in fact most likely much lower than many present-day insurance co-pays. Furthermore we could have the test done at our convenience without having to say "Mother, may I."
I'd love to have a discussion about this general subject. The public needs to be informed about why medical costs are high and increasing and at the same time why responsiveness to public demand is so limited.