"It appears that consolidation has resulted in the possession and exercise of health insurer monopoly power," the study says. AMA says those monopolies have increased premiums, watered down benefits, and increased insurers' profitability, which the physicians' association says demonstrates that highly concentrated markets harm patients and physicians.
Pauly says he'd be more sympathetic to the complaints of physicians if they "are willing to break up some of their doctor market power as a quid pro quo."
"Of the two kinds of non-competitiveness, I'm more worried on the non-competitiveness on the seller of services side than on the insurers' side, because insurers can be replaced fairly easily," he says. "There is nothing special about a Blue plan other than some consumer loyalty to the trade name. But there is something special about your own doctor, and hospitals are not so easily interchangeable."
Wright believes the AMA study and the AHIP response inadvertently say more about what is wrong with healthcare delivery than the two sides' accusations and counter-charges about monopolistic practices.
"The sad part is that our healthcare costs are more dictated by the healthcare market than they are the actual delivery and quality of care," he says. "Healthcare prices and healthcare premiums are much more a function of the providers' and insurers' relative market positions than they are about the cost of providing care of the quality of the care provided. Under our current healthcare system, that is what dictates our prices more than cost and quality, which are the things that people would presume would dictate the costs."