I agree this is a bad incentive, but a conflict of interest alone does automatically mean an ability to act on it. In the case of health insurance, driving up

I agree this is a bad incentive, but a conflict of interest alone does automatically mean an ability to act on it. In the case of health insurance, driving up the costs requires a monopoly or collaboration of firms without defection. As a result, this means one firm cant act in isolation, and cost increases usually come from the industry not pushing back on outside changes that impact all the firms equally. Examples could be more training for healthcare workers, more expensive standards of care, more regulation and paperwork, ect. It is pretty telling that UHC prices are not that different than similar plans at Kaiser (which is a vertically integrated non-profit insurance, hospital, pharmacy, and PBM provider). About 15% different when I was picking between them during open enrollment this year.