dr. ginsburg. dr. ginsburg: certainly, from a justice that is guided by the age-old trust books, which i think served our country very well, clearly there are judgments that are hard judgments to make. i cannot get into the minds of the officials in the justice department as to how they will not come out. you retire as i think they are very complete. very expect it will be a fair and appropriate process. >> payment data person myself. i ran an analytics practice before he got into politics. do you feel if the process today you have enough insights now? united coming from a different frame about argument in the data, but do you feel like the process appropriately incorporates considerations for the kinds of things you look at when you're studying this? confident in the process from the department of justice. i am wishing of the public had access to the information to perform the analysis. some of therstand competitive elements that had to be taken into account. trendms to me that one with cause the other

dr. ginsburg and dr. dafny, you both have these studies that you're relying on on consolidation, can explain them in more layman's terms? maybe you want to start dr. ginsburg. maybe your microphone there. >> i would say certainly the literature on insurer consolidation is a very limited one, and i think professor dafny's study of the aetna prudential merger, which was 15 years ago and is well regarded, she explained how difficult it is to do these studies. the information on provider mergers is much clearer. >> and what does that show? >> that shows clearly hospital mergers leads to higher prices and without an impact on quality. this is a very extensive literature that's been synthesized by some very good people. nevertheless, i think that there are other dimensions that are quite relevant besides consolidation, et cetera, that either policies -- the policies can make some markets much more competitive. this is what has happened with the affordable care act. >> with the geographic disparities in the coun

dr. ginsburg made earlier. market concentration is just one measure of looking at anti-competitive issues. i'm not an expert on the hh index. i have enough to do in my day job to manage all that i can think about relative to medical loss ratios and the like, but i would say is as we look at the markets where aetna and humana compete, we have 18 competitors in non-rural markets and 10 plans offered in rural markets. entrants have been more than half hospital systems. we view that in the event we get to the point with the department of justice that we need to engage if divestitures, there will be hospital systems that want to enter the medicare advantage market. >> senator, likewise. i'm not completely familiar with the analytics that you mentioned. i would rather respond back to the committee at another time very soon and of course the department of justice regarding their assessment of the combination of these two companies. that's probably the best i can offer at the moment. >> thank you. this has been interes

dr. ginsburg. >> well, certainly the department of justice is guided by the age old anti-trust laws, which i think has served the country very well. clearly, there are judgments that are hard judgments to make. i really can't get into the minds of the officials in the justice department as to how they will come out, but i think they are committed to very extensivebertolini, what are yo thoughts? >> senator, i believe the process is very thorough and complete. we expect it will be a fair and appropriate process. >> dr. dafny, you mentioned -- and i'm a data person myself. i ran a data analytics practice before i entered politics. do you have enough insights in the process now? you and i may be coming from a different frame in the argument the data would support. >> i'm confident in the process of the department of justice. i just wish that the public had some access to the information so that we could perform analyses too. >> i think that's a valid point in terms of transparency, but i understand some of the competitive elements that have to be taken into account. it seems to me one trend w

dr. ginsburg served as the founding executive director of the physician payment review commission. now the medicare payment advisory commission, and as deputy assistant director at the congressional budget office. he earned his doctorate in economics from harvard university. lee is director of health enter pies heist management and the professor in hospital and health servicees at the kellogg school of management. her research examines competitive interaction among pairs and providers of healthcare services and the intersection of industry and public policy. dr. dafny earned' h a ph.d in economics from m.i.t., research associate at the national bureau of economic research, editor of an international journal of health economics and management and a board member of the american society of health economists and the healthcare cost institute. in 2012 to 2013, she served as deputy director for health care and antitrust in the bureau of economics at the federal trade commission in washington. she its a current member of the panel of health advisers for the government congressional budget

dr. ginsburg and dr. dafny, you both have these studies that you're relying on on consolidation, can explain them in more layman's terms? maybe you want to start dr. ginsburg. maybe your microphone there. >> i would say certainly the literature on insurer consolidation is a very limited one, and i think professor dafny's study of the aetna prudential merger, which was 15 years ago and is well regarded, she explained how difficult it is to do these studies. the information on provider mergers is much clearer. >> and what does that show? >> that shows clearly hospital mergers leads to higher prices and without an impact on quality. this is a very extensive literature that's been synthesized by some very good people. nevertheless, i think that there are other dimensions that are quite relevant besides consolidation, et cetera, that either policies -- the policies can make some markets much more competitive. this is what has happened with the affordable care act. >> with the geographic disparities in the coun