Dominos that wouldn't fall: understanding the failure of competitive reform

Ten years ago, there was widespread optimism that market competition would succeed in controlling health cost inflation and restructuring the health care industry in socially desirable ways. Today, many view competitive reform as a failed strategy. Costs remain uncontrolled and both government and private payers are turning to regulation and monopsony power. Formidable and longstanding barriers to price competition in the markets for health insurance and health care services were underestimated. Efforts to promote competitive reform were halfhearted and partially offset by a growth of regulation. What lessons can be learned from the competitive experiment and how will health policy evolve in the future?