Comment by estearum

For-profit pay-viders (payer-provider mergers) should be illegal. In theory they can drive greater efficiencies that pass down to consumers, but in practice pay-vider integration makes available a lot more levers to screw consumers. All of those levers are easier to pull than increasing efficiency of care delivery.

If you want to act as both insurer and provider, then you should have to be a non-profit and have thorough performance monitoring in place to ensure you're passing what's possible back to consumers.