Open competition can't happen because of the extraordinary obfuscation that goes on in medicine. Does anybody know what their kid's tonsillectomy will cost at different hospitals? Unfortunately, the rogering you get from the hospital is separate from the buggerings you'll get from the surgeon, the anesthesiologist, the lab technicians, and the radiologists. Then you'll have everybody getting different negotiated rates with the various insurance carriers. There can't be any open competition in a system as fucked up as ours (yes, I know it's the greatest system in the world!
).
And I'd be tempted to say fuck the doctors too, since they're really one of the root causes of the whole mess, but it's honestly not their fault. Any system that forces people to rack up 300k in dept to become a doctor is pretty screwed up. At that point, it's no surprise that nobody wants to practice family medicine in Baumfoque, South Dakota.
And HSAs, like many other political pipe dreams, overlook human nature. Nobody's really going to put money into an HSA that could better be spent on a 64" plasma screen and a new Escalade to replace the one from 4 years ago.