How does this case describe the complexity of the US healthcare system?

Sam had a hernia, but he did not have insurance and was self-employed.
After 13 years of just pushing the hernia back when it stuck out, he decided to take care of it. He found a reputable local surgical center that offered a flat price of $3,500 for the surgery, which was fully inclusive—
surgeon, facility, anesthesia, and follow-up. He would need to put $1,200 down before the surgery and pay the rest in two installments after the surgery.
He thought this a good deal, and two months before the scheduled time he made the deposit.
Sam was cautious and read the policies and fine print. If he canceled the surgery at least two weeks before the scheduled time, the surgical center would refund his full deposit. If he canceled within two weeks of the surgery date, he would forfeit the deposit. He was nervous but planned to go ahead with the surgery.
COVID-19 hit his area one month before his scheduled surgery.
Sam’s business collapsed and he was very concerned about his finances. The surgery center continued with their surgeries, using special techniques to protect patients, but Sam was still worried. Sixteen days before his scheduled surgery, he finally called to cancel. To be certain he could get his money back, he also e-mailed the surgeon’s office and the surgery center to tell them he was canceling.
Two weeks later, Sam got a reminder about his surgery the next morning. He thought it was strange, but perhaps the doctor’s office had not communicated with the nursing staff at the center. He ignored it, as he had canceled the surgery in plenty of time.