The Wall Street Journal reports on the fact that the five largest commercial health insurers in the U.S. are pursuing various combinations of mergers and/or purchases of one another. In an editorial, The Journal expresses concern about the possibility of “all five fusing into one monster conglomerate.” They call this an oligopoly.

The Journal, explains the phenomenon, saying “the economics of ObamaCare reward scale over competition.” Standardized benefits and premiums have compressed profit margins for insurance companies. There are few possibilities under this system to offer more products to attract customers. These mergers and acquisitions are, in effect attempts to buy more customers. Merging will also allow these companies to combine administrative overhead and other expenses, with the goal of gaining efficiencies to improve their profit pictures.

But why is there this increased standardization of the policies and benefits offered by health insurance companies? It’s because their main customer is, increasingly, the federal government. There’s Medicaid managed care, Medicare Advantage, and, of course, the ObamaCare exchanges themselves. The Journal explains that when most of what these insurance companies do is geared to please this one major customer, the federal government, it “may well be that only fewer, larger, more centralized insurers can survive financially.”

There’s another consolidation frenzy: Hospitals, doctors and other providers are also uniting. Again, quoting The Wall Street Journal: “Hospital mergers have climbed every year since 2009, and in 2014 the number of deals that closed was fifty percent higher than the number in 2009, which was the year before the health law passed.” And hospitals are absorbing physician groups with doctors increasingly becoming salaried workers at hospitals. Regional hospital mega-systems are beginning to dominate certain markets. This is turning out to be more about maximizing revenues than increasing efficiency and improving outcomes.

The Journal admits that healthcare has been consolidating since the 90’s, but under current law the trend has accelerated. The good news is, technological and biological discoveries continue at a rapid pace. But without a healthy set of companies with the incentive to finance and deliver these new products into the system and to patients, this innovation will fall off.

Small hungry companies with optimistic investors would find profitable ways to get new and better healthcare to patients, and make a profit doing it. But, conglomerates, largely dependent on one client: the federal government, will act in risk-averse ways to protect their bottom lines.

Here’s The Journal’s ominous conclusion: “five years into the glories of ‘health-care reform,’ the same antiquated incumbents dominate as they did before, only with less accountability to patients.”

It remains to be seen what the Supreme Court’s ruling regarding federal subsidies will do to the healthcare system. But we ought to use this opportunity to create something that employs state innovation and free markets before we devolve into a single healthcare behemoth controlled by the federal government. It’s really now or never.