Because I will be discussing much of the material originally intended for this paper in my Krooss Presentation, this presentation will instead focus on current implications of the insurance-company model. I argue that an interplay of public and private power caused the health care system to develop around a specific organizational modelthe insurance company model. Understanding this model explains why the U.S. health care system has such high costs and fragmented care. Policymakers structured the recent 2010 Patient Protection and Affordable Care Act around the insurance company model, so I will also offer a few thoughts about how the reforms may unfold.