True. My assumption is that there's a complete lack of the usual consumer protections because (a) no ability to shop around and (b) no political will to fix it

True. My assumption is that there's a complete lack of the usual consumer protections because (a) no ability to shop around and (b) no political will to fix it because most bills go to insurance companies who (i) are expert at questioning medical bills and (ii) have a negotiated relationship with providers so they don't pay sticker price anyway.