Capt. Louis Renault’s famous line in the movie "Casablanca" comes to mind as I behold the reaction to the journalist Steven Brill's 36-page report "Bitter Pill: Why Medical Bills Are Killing Us," published in a special issue of Time last week. Americans are shocked, just shocked. But what they should have known for years is that in most states, hospitals are free to squeeze uninsured middle- and upper-middle-class patients for every penny of savings or assets they and their families may have. That's despite the fact that the economic turf of these hospitals—for the most part so-called nonprofit hospitals—is often protected by state Certificate of Need laws that bestow on them monopolistic power by keeping new potential competitors at bay.