Romer's cartel-

from wikipedia

In microeconomics and management, the term vertical integration describes a style of management control. Vertically integrated companies in a supply chain are united through a common owner. Usually each member of the supply chain produces a different product or (market-specific) service, and the products combine to satisfy a common need. It is contrasted with horizontal integration.
Vertical integration is one method of avoiding the hold-up problem. A monopoly produced through vertical integration is called a vertical monopoly, although it might be more appropriate to speak of this as some form of cartel.
Nineteenth century steel tycoon Andrew Carnegie introduced the idea of vertical integration. This led other businesspeople to use the system to promote better financial growth and efficiency in their companies and businesses.

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when portions of this bill are deemed unconstitutional (i.e. the 5 patient limit) the model will fail.

Nobody has shown me how 1284 makes patient to patient sales illegal. Patient to patient selling will also pickup in a big way (IMO) as people realize if they aren't a caregiver, almost none of the restrictions in 1284 apply.. though we do gain from the recognition of increased counts in the bill. So, a husband and wife team, both with signoffs for increased counts could be at 99 plants without having a single patient.

think about that for awhile...