By Evan Falchuk

It’s a secret, hiding in plain sight.

A recently-released GAO study of the health insurance market (.pdf) found:

• The median market share of the largest insurer in each state was about 47%

• The five largest insurers in each state control 75% or more of the market

• In 23 states, the five largest insurers control 90% of the market

Health insurers look like — and some might say, act like — your cable company.  They’re pretty much regulated that way.

But it’s not just insurers.  In the last two decades, there has been an equivalent consolidation of hospitals.

It shouldn’t be a surprise, then, to find hospitals and insurers cutting highly questionable deals that make each other lots of money at the expense of everyone else.

We know what to do about this.  In America, we try to introduce competition to fix problems like these.  Maybe this is one of the motivations behind the idea of a government-sponsored health insurer.  But wouldn’t it be much simpler to open up these markets to real competition?