I think you're right. The issue with these services is that they're extremely local. Really, only cities will likely really have much competition. That relies on there being separately owned facilities. And even then there is the issue that 2-3 providers never really compete even if they're not colluding...

I honestly think that free market healthcare is doomed to failure. The information a-symmetry, the size of hospitals compared to populations, localization, the degree of specialization, strategic nature of services, and the social externalities are just too great to ever really have a market. But that's just me on my soap box.

Hopefully transparent pricing will do some good at least. I wonder if requiring insurers to share savings in cash would further encourage people to shop around (eg going to the place 4h away to get a 2k MRI instead of a 4k MRI means you get say half the saving [1k] back from your insurer)...

There will never be 10x as many providers due to the AMA and lobbying. Existing interests don't want to see lower prices and competition.

If this was possible, I'd agree with you. But the reality is that the best we can hope for is single payer.

I was arguing with a doctor friend recently about the AMA. He's on team New York Times, "knows" the Koch brothers are Satan incarnate, "knows" Trump owes Russian oligarchs money, etc.

It just didn't register that the AMA is the sixth-biggest spending organization on DC lobbying [1], right behind Blue Cross Blue Shield (an insurer) and the American Hospital Association.

People worry about the NRA and all kinds of other stuff. They should really get mad about how outrageously the medical industry lobbies (as do the realtors), and how much they've managed to extract from ordinary Americans. It's an utter coup of PR that people aren't rioting in the streets about this. Everything about the medical industry -- licensing, high physician salaries, etc. is rigged to be good for insiders.

[1] https://www.opensecrets.org/federal-lobbying/top-spenders