Much has been made on the left and right of how monopolist the HMO Act was and is. Also insurance is tied to employment, so it seems like it would be hard to go back to a truly free market in health care unless there was a punitive fine on that benefit, but that seems like it would cause more harm than good. So at this point it seems like that is off the table in terms of reform.

As for the HMO Act, the government gave money to insurance companies like Cigna and United Healthcare as well as Kaiser health to build a monopoly over non HMOs. Would breaking them up at this point be akin to Ma Bell, or more akin to Microsoft in terms of justification? It seems like one instance where I could seem truly anti-competitive behavior being an issue, influenced by the government.

The one thing that seems like it could work (and there is a lot of talk on this), but encourage grey market medical good to be imported, liberalize licenses for doctors to practice medicine, and perhaps create a groupon like app that would allow people to buy directly instead of having as much red tape. Also maybe allow government negotiations for Medicare and Medicaid, although overall I can see both pros and cons to that. Also encourage medical tourism.