In a state like New Jersey, we find that the anti-trust laws are applied selectively, allowing insurance companies to achieve nearly oligopolist status, while the provider community remains highly fragmented and, therefore, disadvantaged at the bargaining table.

Over the years, I have worked in several large integrated delivery systems with active acquisition and integration strategies, including those intended to improve physician alignment. In my experience, in MI, NY, and MA, anti-trust laws were always an important strategic consideration, however, they were not barriers to progress, in the end. In my view, these laws are important and ultimately enable free trade, however, I agree with Peter's point, completely. Applying the laws selectively creates unintended consequences that could ultimately undermine the market. As our industry continues to evolve, the anti-trust laws may need to be reviewed to ensure that physicians and hospitals have the appropriate "freedom" to consider and develop innovative care models intended to improve access to care and quality, mitigate decreases in reimbursement, and increase operating efficiency - all things that in my experience support well thought out health system development and physician integration activities.