A panel of experts met at the University of Pennsylvania's Leonard Davis Institute of Health Economics (LDI) to discuss potential innovations that states might use to reduce health care costs in consolidated hospital markets where little competition exists. The possibilities ranged from state cost commissions, and global budgeting, to public options that create state-run health insurance programs. Major challenges cited by participants included the weak regulations, lack of oversight, and failure to contest mega mergers that characterize most states' approach to the issues of health care cost and hospital consolidation.