[janalsncm]

> competitiveness between insurance companies

Maybe we should question this assumption that insurance companies intend to compete. It strikes me as very difficult to compare insurance companies. Some of them don’t even keep up to date information about the doctors that are in network (you have to call the doctor to ask).

[nradov]

Payers (insurance companies) do compete aggressively, but they mainly compete on issues relevant to benefits administrators who make the decisions at large employers about which health plans to offer to employees. Those administrators need to hold down costs for self-insured employers, and having larger provider networks means higher costs.