For the past decade, antitrust enforcement and policy have highlighted the growing size and power of big tech platforms. In a new opinion piece, two experts who worked in the U.S. Department of Justice's antitrust division argue that a few huge health care conglomerate platforms have many of the same concerning traits as big tech platforms. In suggesting that policymakers and stakeholders look beyond the individual services provided by each platform, they recommend that antitrust attention and action may be needed.
The essay, by a professor at Carnegie Mellon University and a lawyer, is published as an opinion piece in the Journal of the American Medical Association.
"The largest U.S. health care companies are no longer just health insurers, pharmacy benefit managers, physician practices, home health agencies, hospices, data warehouses, data analytics firms, or hospitals; increasingly, they are all of the above," explains Martin Gaynor, professor of economics and public policy at Carnegie Mellon's Heinz College, who coauthored the essay. Gaynor is a former special advisor to the assistant attorney general in the U.S. Department of Justice's antitrust division.
"The creation of 'big health care' platforms risks worsening the already serious problem of monopoly power that plagues health care in the United States," adds Gaynor.
Consolidated health markets have failed to deliver better care, lower prices, increased access, or improved population health, according to Gaynor and his co-author, Jonathan Kanter, a lawyer and the former assistant attorney general in the U.S. Department of Justice's antitrust division. Instead, after decades experimenting with consolidating health care, concentrated markets have spurred higher consumer prices and spending, without improvements in quality or gains in efficiency.
Past consolidation efforts have involved players in a few segments of the health care system, but in recent years, the trend has been toward the emergence of large health care platforms built by mergers and acquisitions that span the range of the health care ecosystem—what the authors call the "platformization" of health care. As a result, multiple firms encompass many different parts of health care, all operating under one corporate owner (e.g., UnitedHealth, CVS Health). In this way, they say, big health care today has many characteristics of big tech.
Among the negative effects of platformization are barriers to entering the health care system, changes in the nature of competition that make it harder for smaller firms to survive, conflicts of interest, and incentives to circumvent or exploit regulations. Furthermore, the dominance of large systems not only prevents fair competition, it also denies independent physicians, practitioners, and pharmacists the ability to compete fairly and build small businesses in their communities. And it thwarts innovation in the organization and delivery of care.
"We are at an inflection point," notes Kanter. "The trends we see are undermining the ability of health care markets to function adequately, making the U.S. health care system even more expensive, unresponsive, and inaccessible. We foresee a not-so-distant future where a few large integrated health care platforms will have acquired a hold over health care."
If these platforms are violating the law, individuals must act to stop the violations and open markets to vigorous competition to prevent further consolidation and concentration, before it is too late, the authors recommend. All appropriate remedies—including traditional structural remedies, such as breakup—should be on the table for consideration, they say.
