Concentration – It’s a Problem

Growing up, breakfast wasn’t complete without a 5-ounce juice glass filled with orange juice—not the oversized tumblers we use today. Back then, there weren’t endless choices like no pulp, some pulp, extra pulp, orange–banana, or orange–pineapple. There was just one go-to brand at my house: Tree Sweet—the one with three smiling oranges wearing little green-leaf hats on the label.

And it didn’t pour. It plopped.

Orange juice came from frozen concentrate packed in a 6-ounce metal can. Making it felt a bit like a kitchen science project: add three cans of water, stir, and keep stirring—no matter how tired your arm—until the last icy chunk reluctantly melted.

As old-fashioned as that sounds today, frozen orange juice concentrate wasn’t just convenient; it was revolutionary.

A Short, Sweet History of Concentration
Frozen orange juice concentrate wasn’t just another pantry convenience; it was a wartime innovation. During World War II, the U.S. government needed a way to get vitamin C to troops without subjecting them to the notoriously awful lemon crystals they refused to drink. Scientists, with help from the Florida Department of Citrus, figured out how to evaporate water from fresh juice at low temperatures and then add a splash of fresh juice back in to restore flavor. The result: a concentrated orange essence that froze well, shipped well, and tasted like…orange juice.

By the late 1940s, concentrate was a sensation. It was cheap, easy to store, and sold as a modern miracle. For decades, frozen orange juice dominated breakfast tables—until the 1980s, when “not-from-concentrate” juice entered the scene with glossy cartons, fresh-squeezed imagery, and the now-famous Tropicana orange with a straw sticking out of it. Convenience won again.

Today, concerns about sugar and processed foods have chipped away at juice’s health halo, but concentrate hasn’t made much of a comeback. The market is simply too…concentrated.

When Markets Get Too Concentrated
Which brings us to health insurance—another story of concentration, but without the sweetness.

In theory, competitive markets lead to innovation, lower prices, and better choices. In practice, most health insurance markets today look less like a bustling farmers market and more like a sparsely stocked aisle with the same two or three brands.

According to a 2024 GAO report, in at least 35 states, three or fewer insurers control 80% or more of the market. Medicare Advantage markets are similarly dominated by just one or two carriers, especially in rural areas.

Concentration is getting worse. Insurers are pulling out of ACA and Medicaid markets in several states, including Michigan. Medicare Advantage plans have exited markets for 2026. With higher premiums for 2026, and the loss of enhanced ACA subsidies, consumers are left with less choice and higher costs.

And concentration isn’t staying neatly on the “plan” side. Provider markets have become increasingly consolidated over the past 30 years, contributing to the rise of large health systems. Research shows that consolidation leads to higher health care prices. Several studies have found that it also drives higher overall spending, reflecting both the price and volume of care. The bottom line: concentration leads to higher prices and less choice.

A New Kind of Concentrate
Concentration made orange juice affordable and accessible. But concentration in health care markets does the opposite: it drives costs up and choices down.

If only fixing health care were as simple as adding three cans of water and stirring.

Happy reading,
Suzanne Daniels, Ph.D.

Enjoy the weekend!

Best,
Suzanne
Suzanne Daniels, Ph.D.
AEPC President
P.O. Box 1416
Birmingham, MI 48012
Office: (248) 792-2187
Email: [email protected]

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