You don't need everyone shopping around. You just need enough to drive the market, it isn't even necessarily a majority.

Kind of like how list price means everyone pays the same price for a car? What would happen is more of what we already see: tons of addons being pushed, rebates or other ways to adjust prices for some people without lowering them, random specialists and unnecessary services being pulled in relying on the fact that most people don’t realize they can and should say no, and a whole industry of people finding ways to say you had some obscure complications not covered by the standard price.

Look at it from an economic incentive standpoint: Americans pay 2-3 times more for the same service. That is a huge amount of money, and it ensures that rooms full of smart people will be working to ensure that their employers continue to get it.

Flip side you can actually shop around for the best car price. Can’t even do that at us hospitals

Exactly - it’s not a normal market and there are hard limits preventing it from ever working like that, no matter how many people desperately try to pretend otherwise because it’s personally profitable for them.