I have over the years linked a story about healthcare costs. Chattanooga, called "the buckle of the stroke belt" had the cheapest healthcare. Georgia (southeast or southwest) had the highest.
The reason was competition, Chattanooga had an unusually high number of unaffiliated doctors. That area of Georgia had one corporate provider.
Costs like this make it much harder for a an individual doctor or a small group to compete with the corporate.
Years ago I had a doctor whose group was in negotiation with Anthem. I asked him about it, he said it was a huge time suck meeting with Anthem, meeting with his group, going back to Anthem. They were dropped by Anthem for about a year. This was well before ACA, so much for "if you like your doctor, you can keep your doctor".
Here is that article I love.
What sets these bargain markets apart? They tend to have robust competition among hospitals and doctors, allowing insurers to wrangle lower rates. Many of the best deals are to be had in Minnesota, where managed care has long held prices in check.
www.npr.org
IF we had robust competition, maybe the competitive market would work. We do not, it isn't close, so IU Health has to explain a $400 million donation. If we do not have robust competition, and we do not, we need to have the thumb on the scale for the consumer because they are screwed.