For decades, Americans have relied on competition in the insurance market to help make healthcare affordable. But in most of the country, competition hardly exists anymore.

That's a primary reason health premiums are growing nearly three times faster than wages, even as patients spend less time with their doctors and face routine delays and denials. In nearly three-quarters of commercial insurance markets, consumers lack meaningful choices. In Medicare Advantage, roughly nine in 10 enrollees live in highly concentrated markets.

Americans are rightly frustrated about paying nearly $30,000 in premiums for family coverage that squeezes patients at almost every turn. Roughly 70 percent support using antitrust enforcement to break up large health insurance companies. And by a 20-1 margin, voters want to block insurers from buying healthcare providers.

Yet while antitrust powers are an important tool — and should be used — they won't restore insurance market competition on their own. To fix our problems, policymakers will also need to unwind the policies that fueled consolidation in the first place.

A few large insurers increasingly control not only health plans but the entire patient care journey — from doctors and pharmacy benefit managers to clinics and hospitals. That has reduced their incentive to improve outcomes and compete on care quality. Instead, every prescription, treatment decision, and coverage........

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