If it swims like a duck, and quacks like a duck, it probably is a duck!
Similarly if it looks like horse manure and smell like horse manure, it probably is Horse Manure!
However some of those wearing the blinkers, will be taken in by this smelly Horse Shiite.
Rhrosty.

I must be having a particularly bad day, because I couldn't for the life of me work out the point that the author is making here.

On one reading, it would appear that Mr Gadiel believes there is some kind of fundamental difference between the acquisition of healthcare facilities by an insurer, and the acquisition of an insurer by a healthcare company.

"... there are examples of successful vertically-integrated health insurance and health service provision. But these occur when insurance companies have initiated a takeover or have established their own service businesses."

But intuitively, the end result - and the economic tensions that Mr Gadiel alludes to - are fundamentally identical.

"Primary... can profitably underwrite expansion of its health services that will prove costly to its insurance division and its contributors; alternatively, it can attract contributors to low-cost insurance offerings that incorporate cost sharing and encourage patients to make rational decisions about the care they use. It cannot have it both ways."

Why cannot they "have it both ways"? If the objective is to lower costs through more integrated care at as many intersections of individual and the health system as possible, surely the alignment can only be beneficial to the public?

But as I mentioned, I may be missing the author's point entirely - perhaps someone can put me right with a few, clear statements of fact.

Basically, medical specialists can gold plate their treatment of privately insured patients.

An example of gold plating, is if for example you have cardiac by pass surgery as a private patient, you will have a swan gang catheter inserted, even though clinically it is not indicated. As a private patient you will more than likely spend 3-4 days in Intensive care.

The 30 second "Good morning" is going to cost as much as a consultation.

Specialist do not want Insurance companies limiting their ability to 'gold plate', however a vertically integrated service being insurer and provider can limit the ability of providers 'gold plating' whilst they do it themselves.

Insurers in America have been known to deny their clients cover for their medical costs on the flimsiest of excuses.

Denying medical treatment was used as a cost reduction method.