So I understand where you're coming from, and there are certainly major market distortions in health in the US (employer-provided health insurance being the most obvious). But where I live, "which ER will you go to" is a major, market-driven conversation. I have 3 obvious options, and 2 of them are competitive, and if I go look for conversations and "reviews" I'll find plenty of opinions quickly. To me, it's at least as competitive as the market for plumbers.