I worked in aerospace and know a bit about this. Say you want to make a missile. Well, you better have the paperwork for literally every component to show that the metal used in all of it originates from a foundry in one of a tiny handful of countries.
It is funny to see the same story every time. It's all burdensome regulation by the nanny state until something goes very very wrong and the public wants answers NOW, at which point it's incompetent government getting led by the nose by monied interest groups and their public relations departments.
I wanna know what they've been doing with our trillions of dollars, because it sure as heck wasn't making an effective military.
Most of these companies are public and you can find their stats.
A Tomahawk missile is $3.6 million because it uses specialty components, all made in small batches using very expensive American specialist labor. It's also staggeringly more capable than a drone, or a shahed. Those extra capabilities are enormously expensive, because they are hyper niche.
A single American Artillery Shell is $3000.
Meanwhile, your $150k surgery bill example is completely different. It's a fake number, made up to cause a process to generate an actual, intended price somewhere. Your insurer and the hospital play some insane game of chicken where the insurance promises only to pay a percentage of what they are billed and so the hospital submits a fake number to get what they actually want (or nowadays the system is even more byzantine)
There's the cost that the employees pocket, and then there's the share that the shareholders pocket, right? Doesn't "margin" represent the latter?
It’s not like you get to the end of the chain and trade a fistful of dollars with the ingot of aluminum itself.
But isn't there a conceptual difference between the "owners" of the Tomahawk factory vs. the people who are actually putting the missiles together?