I cannot pick my own health insurance company. My choices are: - Whatever my employer wants - Something on the exchange for quadruple the price (particularly

I cannot pick my own health insurance company. My choices are: - Whatever my employer wants - Something on the exchange for quadruple the price (particularly without my employer's share of premiums) How does the market decide when it isn't a competitive market? Why are employers allowed to pick their employee's health insurance? Why are employed people at large companies paying less than employed people at startups?