Should insurance companies be able to pressure you into using their own health care providers?

MINOT, N.D. — The fundamental problem with the American health care system is that those who ultimately receive the care aren’t in the driver’s seat.

When we go to the doctor or are admitted to the hospital, we aren’t really the customer for the care.

According to the American Medical Association

, in 2020, just 9.4% of all health care spending came directly out of pocket. Most care was paid for by private insurance plans or, far more often, the government through programs like Medicare and Medicaid.

Even most of us on private insurance plans aren’t really in control. Employers pick the insurance plans employees use. We may get to make a few choices around the edges, but for the most part, we take what we’re given.

This lack of choice is why health care costs have spiraled, growing at a rate that is multiples of other household expenses, such as rent, clothing, food, and even energy. Market forces, like competition among providers, keep prices in check. Or, at least, they keep them from growing as fast as they could.

But market forces are predicated upon individuals making choices. How many choices do we have regarding health insurance and health care?

Not many.

And, increasingly, as the health care and health insurance industries become indistinguishable from one another, the choices available to us narrow.

Taken medical industry behemoth Sanford, for example. That organization operates hospitals and clinics that provide care, sure, but it has also entered the health insurance market. Now it’s using the price pressures that are possible thanks to this vertical integration to limit the choices we have when it comes to health insurance.

It works like this: A vertically integrated health care and health insurance company will offer an insurance plan with coverage for both in-network and

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