How does a large academic medical center navigate questions about whether more competition in its market would improve quality and reduce costs? In particular, how does the system effectively raise concerns about facilities that enter a market to serve mostly commercial patients, leaving Medicaid and uninsured patients to seek care in emergency departments? Regulators are tired of hearing the arguments about how healthcare is “different” from other sectors in terms of the economics of competitive markets, and many states have repealed antiquated “certificate of need” legislation and other state-level market controls on new entrants. Is it possible for a large academic medical center to address the competition issue in a balanced manner that is not vehemently defending the status quo or otherwise coming across as blatantly self-serving? What is the proper role of regulators in ensuring that new facilities and providers agree to serve Medicaid and other low income patients?