I’m sure it’s crossed the mind of many people in the industry. But it’s a comprehensive taxonomy of all diseases, medical conditions, causes, procedures and treatments. Starting from scratch would be much more expensive than just paying the licensing.
Here in California, Senate Bill 478 bans many junk fees, such as the mandatory "service fee" to buy a concert ticket. It's a stretch, but I could see an argument that if hospitals use a billing system that's incomprehensible without licensing an expensive codex, then the hospital is on the hook to provide the codex to you.
In that case its probably cheaper for most organisations just to pay the license fees than risk paying legal fees which would probably be more, even if they won.
