Michael Hiltzik: America's healthcare system is failing because competition is disappearing

The two major afflictions besetting the U.S. healthcare system are that its prices are too high, and that although big spending should give us better quality of care, it doesn't.

These two conditions arise from the same cause: American healthcare is becoming less competitive. Hospital chains are growing larger, and within some specialties, providers have become more concentrated.

The result is that Americans get the worst of all possible worlds. Only two conditions can keep prices in check_competition, or regulation. The utility sector is monopolistic, but also price-regulated. As American healthcare becomes increasingly monopolistic, the absence of utility-style price controls means the sky's the limit.

The late healthcare economist Uwe Reinhardt, and his colleagues saw the consequences clearly in his seminal paper on the fundamental malady of our system. It was titled, "It's the Prices, Stupid."

Lack of oversight result not only in higher prices, but lower quality. As a new study of the dialysis industry asserts, the acquisition of thousands of dialysis centers by major commercial firms resulted in higher hospitalization and mortality rates of patients and less access to