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The real negotiation in medical charges for the uninsured is not how much of a discount you are going to get but what the payment plan will be.

In addition, even if you are lucky and get a surgeon to completely wave his surgical fee, you are still going to be on the hook for the hospital or surgical center charges which will easily be 2-5x that of the physician's. Here you are dealing with a corporation and so will not likely to be able to speak one-on-one with somebody with the power to give you a discount.

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You are correct in what you point out. You are also correct that the government is suppose to get the highest general discount, you are incorrect in saying that they can not offer a greater discount on a deal basis if there is a compelling documentable reason. Even still they can certainly offer a self pay discount and frequently do, you can check with your phisicians office ahead of time, and like I stated above, yes once something has happened it's too late and really what you are negotiating for is a payment plan. Fortunatly in the US they can't impoverish you over medical bills.

I, like yourself also had an incredible hospitilization bill that actually was a fair bit more significant that wht you are saying. I paid most of it out of my pocket, but the one thing that was made very clear to me is that these items are quite negotiable and that there is room to work out items assuming you have time. Most people neither take the time or have the patience ot do this and an insurance provider normally already has a preset good deal for you, such that it is just better to have insurance.