[hibikir]

Even when it's not the insurer, it's at least a hospital. Many a doctor around me that used to have a private practice sold to one of the hospital chains, as they promised more money than by owning, solely due to superior collective action advantages. A large insurer can bully a private practice into cutting costs, but a hospital network that handles 40% of ERs in the metro area? The insurance company can lose. So everyone makes more money but the people paying insurance.

[dnissley]

On top of that the ACA prevents new physician owned hospitals from being established and placed restrictions on expansions of existing ones

[MostlyStable]

Are you talking about Certificates of Need? Those have been around for a lot longer than the ACA [0]

[0] https://en.wikipedia.org/wiki/Certificate_of_need#History

[estearum]

To be fair, this is because there's long-standing [but disputed] evidence that healthcare providers drive up costs/utilization when they can refer to hospitals they have equity stakes in.

Messy business!