Lela, there is no free market when it comes to medical care, allowing insurance across state lines, hell, the only insurance provider left in Alaska is Blue Cross and they are banking record profits offshore.  Providence hospital a non-profit has a billion in savings, I believe ADN published an article regarding that.  I was quoted one price for a procedure for paying cash, when I got there they quoted me a much higher price when they learned I had insurance, still had to pay cash due to a large deductible, so where's the competition.  Why is Blue Cross willing to send you outside the state for care, because it's more affordable.  Try finding a doctor that will take you as a patient if you are on medicare.  It's a mess.