Competition naturally degrades over time as companies go out of business and consolidate.

And it naturally improves over time as companies challenge established players and “distupt” the market. As long as the barrier to entry remains sufficiently low, there’s no reason for a net degradation in competition.

Large companies tend to become less efficient. Yes, they have economies of scale, but they tend to scare away innovators, so they switch to lobbying to maintain their edge.

The correct approach IMO is to counter the lobbying efforts of large orgs, and that means stripping governments of a lot of their power. Regulations tend to result in more monopolies, requiring antitrust to fix, and as you noted, that’s extremely rare.

Do you think a more direct “medical patient union” would work? Skipping a government intermediary?

Yeah, that can work. I’m thinking of having your primary care orovider offer your “insurance” policy, and they’d be on the hook to fund any procedures you need. So they have an incentive to keep you healthy, and that agreement could be a legal obligation that the doctor is doing their best to keep you healthy.

I do think we should socialize emergency services though. If a paramedic determines you need an ambulance ride, that should be free.

I’d prefer socialized healthcare over single payer

I prefer privatized care with transparency in pricing across the board, shortened patent durations, and some government assistance for the poor. But failing that, socialized care is probably the next best. Anything in the middle just breeds corruption.