> So you end up with this marketplace constricted by overregulation — some well-meaning but often basically occurring because of protectionist moats and regulatory capture

Don't hand-wave your claim of overregulation, be specific and name the regulations you think should go away.

In the USA/Canada number of doctors minted is caped by the cartel of doctors.
That costs non-trivial money and lives lost.

Source: https://thedailyeconomy.org/article/how-congress-created-the... and many others

How Congress Created the Doctor Shortage | The Daily Economy

Why don't we train more doctors? Congress froze medical training in 1997, intentionally creating artificial scarcity.

While important, this is immaterial to the NBC article. The PE firms CUT the number of employees in ER rooms in this paper, so having more doctors wouldn't actually help out the problem that the NBC article is describing.

"The increased deaths in emergency departments at private equity-owned hospitals are most likely the result of reduced staffing levels after the acquisitions, which the study also measured, said Dr. Zirui Song, a co-author and associate professor of health care policy and medicine at Harvard Medical School."

The issue with American healthcare is the profit-seeking capitalists.

> The issue with American healthcare is the profit-seeking capitalists.

Profit seeking capitalists would be fine if healthcare was a competitive market, like grocery sale.

But it isn't, and I honestly don't see how to make it one. Full price transparency would help, but I don't believe classical free market selfregulation can work out for the healthcare sector, by design.

You need good ability of healthcare customers to judge quality of treatment/medication, to know prices beforehand and to have sufficient choice for market dynamics to work, and every single one of those points is somewhere between really difficult and impossible.

In what sense do you mean that healthcare isn't a competitive market? Are you talking about locales with only one nearby hospital? I'm in a big city and I have 3 of them, and the choice of 5 different major provider chains. I don't like the system (I think provider abuses are the major cause of health spending problems in this country), but one thing I can't say is that I don't have options.

What I mean is that the dynamics of healthcare are not conducive for a competitive market.

Compare grocery shopping:

You have frequent/repeated interactions; if you always get ripped of by one shop, you can go to another. Before you go grocery shopping, you will have a decent mental model for: prices levels at each shop, quality of produce and accessibility/distance. You also have the full choice in where to go, basically every time.

Hospital interactions (especially ER) is the polar opposite:

You will have few interactions with it over your lifetime (hopefully), costs are basically impossible to know beforehand (and difficult to compare, too), quality of treatment is extremely difficult to judge as patient (because every case is somewhat unique, and outcomes can easily come down to luck/individual doctor). Especially in the ER case, you often don't even have a real choice of hospital and even in cases where you could (and had all the info) there might be throughput limitations on "desirable" hospitals that prevent you from switching (=> having to wait for 5 months).

Another factor I think is that hospitals gain less from being "good": As a "good" grocer, you get to steal market share from your competition at low cost and risk to yourself; for the hospital, scaling up is more difficult and risky, thus "good" competitors are also less threatening comparatively (thus less of a motivation to improve things).

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.