Instead of insurance companies competing for millions of individual customers, they are vying for maybe thousands of business customers. Except that the insura

Instead of insurance companies competing for millions of individual customers, they are vying for maybe thousands of business customers. Except that the insurance companies don't seem to care at all about giving small businesses a good deal, so subtract them from the pool of potential customers that insurance companies care about. Really big businesses don't buy insurance, they just self insure, so insurance companies aren't competing for those customers either. Employer provided insurance absolutely reduces competitive forces (among other problems it causes, as you point out).