@silas like you would theres a pretty old article about it http://www.freenation.org/a/f12l3.html

but apparently a nontrivial amount of people got their healthcare through some equivalent of an independent union, and since the unions had no state interference you were pretty much free to start one whenever, so they were subject to market forces to offer good deals to their members.

there were also a lot more medical schools back then, and a lot more lines of research open, so that too pressured costs down.

the downside is metaregulation fails sometimes. if you don't join a club that checks people on your behalf, its much easier to employ a total quack, but the upside is there are a lot more practitioners and the good ones are more able to route around bad actors, so its pretty much up to you to figure out what cancer doctor you want (or have someone deal with it for you)

of course this is also when you could get doctors to come to your house, people had a family doc who did so, and pharmacies weren't medical shackles where you have to constantly beg continued permission to have drugs you need to live (you just, go buy them. the scrip is a doctors *opinion*, and that's why they are historically called opinions.)