The greatest single cause of outrageous medical costs has nothing to do with monopoly.  It's purely financial, and it's called fee-for-service billing.  More services, more fees.  The more automated the services, the less it costs to provide them (low-level employees without much training can do the work) and hence the more profitable they are. The insurance industry, which fostered this system for decades, now regrets it, but not too much, because they can always raise the premiums and take denying coverage--now a major industry tool for protecting the bottom line--another step up.  Finally, the providers and the insurers together have hopelessly muddled pricing  with their medically meaningless "in network" and "not in network" distinctions.  This renders the published cost for a service meaningless, because the insurer and providers collude in billing outrageous amounts and then settling between themselves for more reasonable figures.  Patients?  They're completely out of the loop.