Anyone who talks frequently to physicians will quickly learn what the single biggest problem in American health care is today: health insurers are oligopolies. Federal law forbids physicians from collectively bargaining a standard fee-schedule with third-party payers.

That sounds fair enough when you think of the humble country doctor, his stethoscope stuffed in his black bag, calling on widows in their homes and having to send his claim to a Fortune 500 insurance company with a multi-millionaire CEO. Regrettably, things are not so simple. Certainly, physicians used to have more power than they do today. Physicians founded Blue Shield and hospitals founded Blue Cross in the 1930s, when hospitals were closely allied with physicians. In the 1960s, however, physicians lost control of the Blues, when representatives of the public joined the boards of many plans. In addition, commercial insurers, who had no collegial relationship with physicians, expanded steadily into health insurance.

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