Red states are where they get away with that nonsense. (Blue states have their own particular brand of nonsense, but I agree with most of it.) Sales tax doesn’t just differ from state to state. Cities and counties are able to have different rates.

As for medical bills, the poor have Medicare, so they don’t pay much and most everyone else has insurance, although the coverage varies widely. My recent surgery cost $130,000 but I’m only on the hook for $3,600. The prices assume insurance companies will cover most of it. If a person has no insurance, they charge less although it can still bankrupt someone.

Where people really get screwed is when the insurance company decides not to cover something, usually on a technicality. The system is totally insane, but healthy people with insurance are oblivious so they don’t care and Congress people are getting too many campaign donations from insurance companies to change anything.

Medical care is a for profit product. Hospitals and doctors advertise. People have gotten so cynical that some don’t trust they need COVID vaccinations because they know there’s a profit motive in promoting them. I could go on but it’s too depressing.