Competition in the market does precisely nothing when there are few participants, all of them shysters (due to high barriers to entry), and there is no meaningful adult supervision. Note that the libertarian crowd would like to ban the adults from the room because it increases freedom.

When I was in the ER last (knife accident in the kitchen) I asked the front desk lady if they could bill me through an honest coding service. I even offered to pay extra for an error-free bill. Didn't prevent them from tacking on the tetanus shot I never got.