Nothing except that it creates a monopoly and a monoculture.

There are many procedures you may not be able to afford out of pocket, so the only way to get them is to choose a provider that covers it. If there is only one provider and they don't cover it, you no longer have that option.

And because nobody else does either, that medical procedure stops being offered because there aren't enough patients to justify it if they all have to pay out of pocket and most can't afford it, even if you were one of the few willing to scrape together the money. Which might not have happened if some insurers had covered it, even if many didn't.

> You have a Sophie’s choice of who you want to pay to buy into this crazy system. There’s no transparency in how services are priced or provided. You as a consumer have no insight into how prices are negotiated between the insurer and providers, nor how providers are paid out.

The existing system is a dumpster fire to be sure. So why not fix it?

Eliminate even the concept of negotiating prices, as if medical pricing is something to be haggled over at a bazaar in Calcutta. Require every provider to publish their price, and then that's their price, and anyone can compare providers.

Which gets rid of the concept of "in network" and all of that nonsense. The insurance pays e.g. 90% of the median price of that procedure within 100 miles of your home, the equivalent of a 10% copay. Then you can choose any provider you want, anywhere you want, and pay their published price. The difference comes out of your own pocket, so you have the incentive to be price sensitive -- but if you want to pay a little more to save yourself an hour drive, you can do that too. And if you pick one that charges less than 90% of the median price you can put the rest in your HSA.

The thing about regulations is that the most important thing they can do is to ensure that markets are competitive. The existing healthcare regulations in the US not only don't do that, they do the opposite. But they don't have to.