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.