Jgd, I think you're confused. Competition among insurers already exists, at least theoretically, it's in the ACA, but the department of health has not implemented it. It won't make any difference in premiums anyway as those are driven by the cost of care. In the U.S. there is no real price competition among doctors, hospitals, medical supply and equipment companies and pharmaceutical companies, and that is one major reason why costs are so high. Another is that there are no price controls as most other countries have. Medicare, our largest insurance carrier is PROHIBITED by (republican) law from negotiating drug prices with pharmaceutical companies. Can you imagine the negotiating power they would have? It would make Wal-Mart look small!  Lastly, insurance companies don't really insure anything, they process claims according to the policy you have signed up for, and take an average of 20% of every dollar that flows through them.