I'm guessing current laws were written around the "managed care" (HMO/PPO) system, the previous (70s-90s) attempt at healthcare reform. For that one, the theor

I'm guessing current laws were written around the "managed care" (HMO/PPO) system, the previous (70s-90s) attempt at healthcare reform. For that one, the theory was that the payment/administration bureaucracy was the cause of the health care cost problem, and that by having insurance companies buy hospital service in bulk rather than doing individual-service billing the overhead could be reduced and accountability would be increased. This requires insurers to be able to assign customers to hospitals and doctors that work for them for it to work.