There is no competition. The day there is competition is the day you walk in to your doctor's office and the prices are posted above the reception desk like a restaurant menu. $50 general visit, $75 for a broken arm, $100 treat common infection, etc. You don't see prices because you don't pay. Insurance pays. If you are ever without insurance and have to pay, they always have different, lower rates. Doctor's scamming insurance companies, insurance companies scamming the government, the government scamming all its citizens.
This is the root cause, the fact people don't pay for their own healthcare and there's no competition. Then we layer on this huge complicated system to try to contain costs other ways.