You assume that there is any meaningful competition. What we are seeing, across industries including education, is a type of indirect collusion that is keeping prices crazy, not competition. Over regulation is a big piece of what enables all this.
Lack of health care records interoperability (locks patients into a system).
Much of the well-intended regulation around healthcare ends up getting perverted to prevent competition.
https://www.cms.gov/priorities/burden-reduction/overview/int...