Depending on how Health and Human Services Secretary Kathleen Sebelius decides to calculate medical loss ratios — the proportion of premiums that insurers spend on actual medical care (as opposed to on things like 24-hour nurse hotlines or chasing down fraudulent claims) — ObamaCare could cause massive dislocation in the health insurance industry, thus reducing competition and leading to more insurance monopolies, which would then be decried by the very people who caused them.