[rexroad]

Agreed on the diagnosis: the inpatient hospital market does not function as a competitive market. Patients arriving by ambulance do not shop on price. Insurance insulates consumers from marginal cost. Regulatory and capital barriers prevent new entrants. The HCRIS FY2023 data for 3,193 hospitals shows what this produces: a 2.6x median markup to actual cost, with the highest-markup hospitals rarely losing patients to lower-cost alternatives nearby.

Your examples of what works are instructive. Generic OTC, needles, blood panels all share the same conditions: price-visible, consumer-controlled, no third-party payment insulation. The RAND hospital data shows the identical procedure (hip replacement) costing $29K commercially in the US versus $14.7K in Germany and $8.7K in Spain. Same implant, same surgeon training requirements. The patient's insurance status varies; the procedure does not.

Montana's commercial reference pricing is not deregulation, but it creates the price-visibility function you are describing: a known floor price that makes it possible for a purchaser to act on price information. Employers have adopted it nationally with documented savings.