Competition between the private commercial health insurance companies is not controlling health care costs. Competition is a free-market concept proposed by Adam Smith in 1778. Competition works to control costs for some services and products but not for health care. You can shop around for the best price to buy the car you want but you don’t have time to shop around when you have a heart attack. You can learn about all the features a new car might have and become knowledgeable about the history of reliability of a particular car, but unless you have a medical degree and specialized in cardiology you probably won’t have all the information you need to decide who is the best cardiologist for the care you will need. You have to trust your cardiologist to recommend the right procedure for you.