I think part of it is that insurance companies gouge hospitals too. They are an even bigger monopoly with a lot of leverage against any ordinary city hospital.
Hospitals are businesses in developed countries too. Here in Japan, the hospitals and clinics are all private businesses, but the prices are very low, ambulance rides are free, etc. The keys, as far as I can tell, are 1) no consolidation/monopolization and 2) lots of regulation.
We were. Then a few decades of legislative capture, private equity, and neoliberal gibberish about "service economies" drained all of the opportunity out of rural and semi-rural America, consolidating what was left in major metro areas.
