The Affordable Care Act (ACA) called for the establishment of non-profit “Consumer Operated and Oriented Plans” (CO-OP) to offer health insurance at lower prices and with patient, rather than corporate, interests at heart. Almost half the CO-OPs have failed in the first two years, with five failures announced just in the last month. Understanding the reasons why the CO-OPs were set up and why they failed can help us learn important lessons about the potential of government and private enterprise not just in the health care sector, but in all areas of the economy.