Healthcare prices are out of control. The average cost of a three-day hospital stay in the United States now exceeds $30,000. A simple MRI can cost $300 in one facility, or $3,000 in another – sometimes in the same city. For working families and employers, these numbers are not abstractions. They can mean the difference between financial security and debt.

Over the past two decades, hospitals have effectively consolidated into powerful, regional monopolies – “nonprofits” with billions in surpluses. All the while, they’ve expanded with enormous government subsidies – Medicare, Medicaid, tax exemptions, 340b, state directed payments, disproportionate share payments, and recent pandemic relief funds. These subsidies were intended to make care affordable. Instead, with guaranteed public revenue, health systems have raised commercial rates, while true prices hide behind layers of billing complexity.

We do not tolerate this in any other industry. Imagine walking into a hardware store and not being told how much a shovel costs. When hospitals are paid regardless of efficiency or outcomes, there is no incentive to control costs. The result: rising premiums, shrinking insurance networks, and opaque “chargemasters” that defy economic sense. This is not a free market. It is a cartel sustained by public dollars and shielded from competition and accountability. Washington politicians, beholden to powerful lobbies, add layers of regulatory complexity, but consumers are left in the dark.

Transparency is the first step toward restoring market discipline. While federal price disclosure rules require hospitals to post their rates, compliance is inconsistent and enforcement weak. Every consumer, employer, and insurer deserves to know what care actually costs before receiving it. Public data should be standardized, independently verified, and easily comparable across hospitals. North Dakota can lead by enforcing healthcare price transparency at the state level.

True competition thrives on information. With transparency, efficient providers will attract patients, while high-cost ones will face pressure to improve or lose market share. Taxpayers would benefit when subsidies reward value instead of monopoly power.

Hospitals deserve fair payment for lifesaving work, and our wonderful healthcare workers deserve recognition. But America should not spend $4.5 trillion a year on healthcare while powerful entities rig the market. Shine light on prices, and more affordability will begin to follow.