Consider the following health insurance plan.

It refuses to pay for certain medical care and then doesn’t offer a clear explanation. It does pay for unhelpful care that ends up raising premiums. Its customer service can be hard to reach or unhelpful. And the people who are covered by this insurer have no choice but to remain with it  or, at best, to choose from one or two other insurers that are about as bad.

In all likelihood, I have just described your insurance plan.

Health insurers often act like monopolies  like a cable company or the Department of Motor Vehicles  because they resemble monopolies. Consumers, instead of being able to choose freely among insurers, are restricted to the plans their employer offers. So insurers are spared the rigors of true competition, and they end up with high costs and spotty service.

Americans give lower marks to their health insurer than they do to their life insurer, their auto insurer or their bank, according to the American Customer Satisfaction Index. Even the Postal Service gets better marks. (Cable companies, however, get worse ones.) No wonder President Obama’s favorite villain is health insurers.

You might think, then, that a central goal of health reform would be to offer people more choice. But it isn’t.