I'm all for increasing supply of doctors but uhh yeah, you really don't understand the dynamics at play here if you think "would be pretty easy to defeat monopolies in local clinics."
Here's a quick primer: You're a doctor in Podunk, Pennsylvania. UnitedHealthcare is the largest insurer in your region, like it is in most regions. Optum wants to move into your town. UnitedHealthcare will cut your reimbursement rates by 70%, requiring you to see far more patients per day, cut your staff, downgrade your equipment, and generally run a shittier business. Once you're finally on the edge of burnout and fully strangled, Optum will come in with a buyout offer. After the buyout (or after you go bankrupt and they just replace you), suddenly UnitedHealthcare is able to restore rates mostly to where they were previously.
Ta-da!
Note if you take the buyout and then regret it and want to break free: too bad. This deal came with an extremely rigid non-compete clause that they will absolutely actually enforce. FTC tried to get rid of these, in large part for this specific use case, but thankfully the American people (read: megacorps) have the GOP looking out for them so that was struck down.
What exactly does marginal doctor supply fix in this particular scenario? Pretty much nothing. All of them have to accept insurance and the vast majority of their potential customers are insured by the same very few insurers.
Re non-profits: I didn't say it "makes them behave better." I said it subjects them to different incentives. Don't strawman. Kaiser in particular is an exceptionally strong organization in pretty much every way except its financial performance. If you think being non-profit isn't a factor, you're just playing dumb.
Here's a quick primer: You're a doctor in Podunk, Pennsylvania. UnitedHealthcare is the largest insurer in your region, like it is in most regions. Optum wants to move into your town. UnitedHealthcare will cut your reimbursement rates by 70%, requiring you to see far more patients per day, cut your staff, downgrade your equipment, and generally run a shittier business. Once you're finally on the edge of burnout and fully strangled, Optum will come in with a buyout offer. After the buyout (or after you go bankrupt and they just replace you), suddenly UnitedHealthcare is able to restore rates mostly to where they were previously.
Ta-da!
Note if you take the buyout and then regret it and want to break free: too bad. This deal came with an extremely rigid non-compete clause that they will absolutely actually enforce. FTC tried to get rid of these, in large part for this specific use case, but thankfully the American people (read: megacorps) have the GOP looking out for them so that was struck down.
What exactly does marginal doctor supply fix in this particular scenario? Pretty much nothing. All of them have to accept insurance and the vast majority of their potential customers are insured by the same very few insurers.
Re non-profits: I didn't say it "makes them behave better." I said it subjects them to different incentives. Don't strawman. Kaiser in particular is an exceptionally strong organization in pretty much every way except its financial performance. If you think being non-profit isn't a factor, you're just playing dumb.