A lot of the problems come from Medicare acting like a central planner that doesn't regulate prices for people outside of their system. Like my local hospital

A lot of the problems come from Medicare acting like a central planner that doesn't regulate prices for people outside of their system. Like my local hospital is blessed, it runs an ER in an area with few hospitals, so Medicare pays it at a higher rate for all care. But Medicare also won't make an agreement to pay for care if someone tries to open up a competing hospital (and investors know this, so they won't bother trying to compete), and they don't tell the hospital that they have blessed that it's not okay to charge ridiculous prices to other customers.