Maybe cartel is a strong word, but there are many states in the US where, in order to operate a medical facility or provide a service, you must get permission f

Maybe cartel is a strong word, but there are many states in the US where, in order to operate a medical facility or provide a service, you must get permission from all of the existing facilities in the locality: https://en.wikipedia.org/wiki/Certificate_of_need https://en.wikipedia.org/wiki/Certificate_of_need This extends to even purchasing medical equipment.