"In addition, device makers typically require doctors’ groups and hospitals to sign nondisclosure agreements about prices, which means institutions do not know

"In addition, device makers typically require doctors’ groups and hospitals to sign nondisclosure agreements about prices, which means institutions do not know what their competitors are paying. This secrecy erodes bargaining power and has allowed a small industry of profit-taking middlemen to flourish: joint implant purchasing consultants, implant billing companies, joint brokers. There are as many as 13 layers of vendors between the physician and the patient for a hip replacement, according to Kate Willhite, a former executive director of the Manitowoc Surgery Center in Wisconsin." A simple legal remedy here would be to invalidate this sort of NDA agreement. The government is already involved as a customer in the health care market, and having the courts simply no longer recognize contracts that prohibit disclosure of prices would bring some immediate transparency to many involved. The law could also go a step further and actually set up/order public listings of prices (this is already done in a lot of industries where vendors try to avoid competing on price).