America’s hospitals:

 Our system lets big hospitals charge exorbitant prices. It’s time for change.

Hospitals that don’t face competition from other nearby hospitals have huge power in their local markets.

Five years ago this week, Barack Obama signed the Affordable Care Act into law, and we've been debating it ever since. Like many Americans, I oppose Obamacare, and I think we ought to repeal it and replace it. Over the past few months, however, I've come to the conclusion that the fight over Obamacare is a distraction from a much deeper problem, which is that America’s hospitals are robbing us blind.

I realize that this is an impolitic thing to say. What kind of lousy ingrate doesn’t love hospitals? Go to any big American city, including cities like Cleveland and Pittsburgh that have been devastated by deindustrialization and joblessness, and you’ll find a mammoth hospital complex in the center of town, buzzing with activity. Forget about big cities—there is a hospital in every congressional district in America, and local hospitals are often among the largest employers in the district. One of the reasons President Clinton’s 1993 health reform effort failed is that he never won over the hospital lobby. President Obama learned from the Clinton debacle; hospitals were among his most important allies. Republicans get in on the act too. Right now, for example, a number of GOP lawmakers are pushing a Medicare “reform” that guarantees higher payments to doctors and hospitals today in exchange for the promise of spending reductions a decade or two from now. Good luck with that.

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