They could all merge into one giant insurance agency, perhaps a National Health Insurance. Once they eliminate all competition the next target for optimisation

They could all merge into one giant insurance agency, perhaps a National Health Insurance. Once they eliminate all competition the next target for optimisation is between the company and hospitals. They realise its cheaper, with better margins, to run primary care facilities rather than hospitals. The government see that they are a monopoly and force them to provide coverage for a minimal monthly cost. It seems like such a good idea that eventually the government agrees to give them a set amount each month for universal coverage of citizens. They rename themselves as the National Health Service.