[EGreg]

There is a simple reason for the "cartel": it's called moral hazard.

You have the monopsony that comes from collective buying power on the one hand. (An argument for SINGLE PAYER insurance.)

On the other you have the usual moral hazard which says, if the customer ain't paying, try to charge as much as possible.

So it's this game of bigger and bigger armies. Same as when countries can't make a peace deal where neighborhoods and individuals long ago could have. A single person can torpedo a deal. It's all or nothing.

It's also why some British bureaucrats in the NHS face the choice of dropping coverage for a drug because the company just won't play ball and charge a low enough price. When are you willing to walk away when you represent a lot of people??