In a libertarian system if some hospital routinely billed excessive hard-to-understand charges, somebody else would open a hospital across the street to compete

In a libertarian system if some hospital routinely billed excessive hard-to-understand charges, somebody else would open a hospital across the street to compete with it. The new hospital could advertise open, transparent up-front pricing (complete with price comparisons), more sensible policies on consultation and out-of-network services, even money-back guarantees. Because the new hospital is so attractive, the old one would lose customers and ultimately either improve its policies or go out of business. This is how the market works with every other kind of firm: if you see an opening to provide a better supermarket or restaurant or department store you can just create it, with no regard to the impact your entry to the market might have on existing providers. Sadly, hospitals are not legally allowed to compete on price. Or compete on service. Or compete at all. You generally can't make a new hospital or expand an old one unless you can convince regulators that doing so won't hurt any existing players. Which means the existing players have no incentive to improve. Open the market to competition, and we would see vast improvement over the status quo. https://en.wikipedia.org/wiki/Certificate_of_need https://en.wikipedia.org/wiki/Certificate_of_need