When a hospital negotiates with, say, Aetna over the costs of its surgical procedures, that hospital negotiator can much more easily walk away from a deal if she is confident that her hospital has a long waitlist for elective surgical procedures, meaning that the other insurance companies in town will bring them plenty of business to remain at capacity.

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Allstate Insurance asked Puris' firm, NTM, to help pull off a "surgical strike" in Chicago earlier this year.

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Despite all of these adjustments, surgical patients on Medicaid were nearly twice as likely to die before leaving the hospital than those with private insurance.

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