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Comment by calebm | Hacker News Reader

I consider myself a "pragmatic libertarian", and by "pragmatic", I mean I'm in favor of legislative intervention when the free market often goes awry. Examples of this would be combating monopolies (since I don't want feudal system 2.0) , preventing immoral practices (like child labor), and controlling prices when there is no competition at work, such as utilities. It seems that with hospitals, there effectively is no competition-driven pricing pressure due to unpublished pricing. This seems like a place ripe for legislative intervention... but perhaps the medical industry is so bad that it would be better to just nationalize it.

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The US government has put in place extremely heavy barriers to open a medical care facility. If we were to allow people to open facilities that compete with hospitals, we would very quickly see advertised prices and dramatic price drops. The medical cartel and all its bizarre non-market activities are a result of the existing legislation in place.

  The US government has put in place extremely heavy barriers to open a medical care facility

That's not true at all. The federal government wouldn't gave any reason to intervene unless you end up falsely billing a Federal program like Midicare, Medicaid, or VA.

The reason for consolidation in ERs is cost -- uf you run an ER, you are obligated to treat anybody who cones in without regard to ability to pay. It's a money pit in many urban areas.

Certificate of need. For example:

https://www.vox.com/policy-and-politics/2018/7/31/17629526/m...

Hospitals in the US not only benefit from unpublished pricing, they also benefit from the situation of customers.

A lot of their customers will be unable to compare multiple hospitals and "shop around", so to speak. Either because their conditions is life threatening, they're actively dying or they're no longer responsive. The ambulance, in any rational scenario, will drive you to the closest hospital in terms of time-spent-driving

So from a corporate perspective it's perfect; the customer arrives and you're legally obligated to start spending money while they are likely unable to object and then you can bill them for it.

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