Chaet offered an example that may support Kliff’s hypothesis about how narrow networks can control costs. When the carrier told area hospitals of its plan to place them in tiers based on negotiated prices, some high-cost facilities volunteered to reduce what Blue Cross had agreed to pay them. They were afraid of losing market share to lower-cost hospitals where patients would have lower out-of-pocket expenses. “We thought one-quarter of the hospitals would be in Tier 1, but instead 55 percent went in there,” Chaet said.

One insurer’s experience, of course, doesn’t mean that the country will relinquish the title of the world’s most expensive healthcare system any time soon. And it doesn’t mean that narrow networks will ultimately prove more popular with consumers than HMOs. But it does provide fodder for the tickler file as these experiments in cost control, American style, unfold.

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Trudy Lieberman is a fellow at the Center for Advancing Health and a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for The Second Opinion, CJR’s healthcare desk, which is part of our United States Project on the coverage of politics and policy. Follow her on Twitter @Trudy_Lieberman.