STAT August 11, 2025
Dan O’Neill

The worst administrative obstacles are imposed by private insurers and incumbent providers

For years, as insurance premiums climbed and Americans worried about medical expenses, economists have pointed to industry concentration as one cause.

That policy conversation, however, usually focuses on how today’s competitors exit the market, through hospital mergers or medical practice buyouts. It neglects the other side of the competition question: whether new providers are able to join the fray or bring innovative service models to patients.

Over the past four years, I helped build a new primary care practice in California, Nevada, and Arizona. We mostly care for elderly people, usually in their homes.

As we’ve expanded, our practice has confronted one reason that health care markets are...

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