IT’S TIME TO BREAK UP BIG MEDICINE

It's just what the doctor ordered.

By Emma Freer and Helaine Olen

The good times roll on for giant healthcare conglomerates. The sector now comprises seven companies in the Fortune 20—up from none in 2000. UnitedHealth Group, the largest healthcare company in the United States, is enjoying record-breaking profits and is the largest employer of doctors nationwide. It and other monopolistic mega-corporations, like healthcare giants CVS and Cigna, own not just insurers but are vertically integrated with medical practices, pharmacies, and pharmacy benefit managers (PBMs).

It's not so great for the rest of us. We face preauthorization requests when we seek care and seemingly arbitrary denials. Patients with asthma and other chronic illnesses routinely leave the pharmacy counter empty-handed, because the largest PBMs play games with which prescription drugs they will cover and at what cost—with sometimes fatal consequences. Employers and unions are being crushed by ever-increasing insurance premium costs, which cut into the wages we would otherwise receive. And all of us live in fear that one illness can destroy not just our physical health, but our financial health as well.

These facts are not unrelated.

Monopolies increasingly control the practice of medicine.

Giant healthcare conglomerates, like any other monopoly, profit not just by simultaneously raising prices and offering worse service but by forcing people to use their services even when there are better and less expensive options available. These corporations’ market power enables them to gouge consumers and squeeze competitors out of business. They view both the people seeking treatment, and the clinicians providing treatment, not as individuals, but as numbers on a spreadsheet—and numbers who can be exploited to improve the company’s bottom line.

As a result, even though healthcare spending is nearing an eye-popping 20 percent of the overall U.S. GDP, we aren’t receiving significantly better healthcare than people in other countries. In fact, we have shorter life expectancies than people living in comparable nations.

There’s a cure for this. We need to break up Big Medicine.

And we at the American Economic Liberties Project are debuting a campaign to do just that.

Consider this: In 2022, nearly all (97%) metropolitan areas had highly concentrated markets for inpatient hospitals, with just one or two health systems controlling 82% of these markets. By 2023, hospitals, health insurers, private equity firms, and other corporate entities employed more than three-quarters of doctors. Prescription drug middlemen followed the same trend; the three largest PBMs, group purchasing organizations, and wholesale drug distributors controlled between 79% and 95% of their respective markets. UnitedHealth Group is the nation’s largest commercial health insurer, Medicare Advantage plan provider, and physician employer; it is also the second-largest health savings account provider, the third largest PBM, and the fourth-largest pharmacy operator. The largest PBM, CVS Caremark , belongs to the same parent company as Aetna, the nation’s fifth-largest health insurer.

This consolidation of patient-facing medicine allows for double- and triple-dipping, where giant medical conglomerates make money at multiple points. They dominate at every point they can. Insurers can interfere with your doctor’s decisions by denying tests, or demanding you take a different medication than your doctor believes is called for—not just because it is the least expensive, or because their AI computer program thinks it is the best for your condition, but because the PBM they own is getting a better manufacturer’s kickback for prescribing it, something you are highly unlikely to know about. When giant conglomerates own doctor practices, they can demand medical professionals treat patients—no matter how complicated their cases—within ten- or fifteen-minute appointment times.

These healthcare monopolies turned Medicare Advantage—initially set up to bring down medical costs to both the government and consumers—into a cash cow, costing the government $83 billion a year[4] in extra payments. They use their own practitioners and access to medical records to diagnose their enrollees with diseases and medical conditions such as diabetic cataracts—without informing patients or providing any corresponding treatment. . However, giant insurers receive higher government payments for enrolling these sick-on-paper patients. This excess money isn’t going to patients. In fact, there is increasing evidence that patients covered by Medicare Advantage are more likely to be denied such services as costly physical rehab services when needed than those on traditional Medicare. Instead, the giant insurance monopolies are using the funds to acquire more medical provider offices, which gives them even more power over the medical system and our care.

This is an unacceptable state of affairs. And it doesn’t need to be this way.

We’ve been here before. After the 1929 stock market crash, Washington intervened to rein in big finance, ultimately leading to the passage of the Glass-Steagall Act. This act separated commercial banking from investment banking and helped lead to middle-class prosperity in the years following World War II.

We need to apply the same approach to the healthcare industry. Reforms around the edges will not cut it. It’s time to enact laws prohibiting insurers from owning middlemen and medical practices and, on the state level, strengthen laws banning corporate ownership of physicians and other medical facilities. This initiative has bipartisan support. During the last session of Congress, Senators Elizabeth Warren and Josh Hawley co-sponsored legislation requiring insurers and PBM s to divest their retail pharmacy businesses. They are anticipated to reintroduce it in the current session. And just last week Rep. Greg Murphy, a member of the GOP Doctors Caucus, said he would like to see United Healthcare “broken up into tiny little pieces.”

It also enjoys support from doctors and other medical professionals. We talked to several recently and here is what they have to say:

● “When we see all around us that the system of vertical integration and financialization of health care has moved the pendulum more on the side of financial gain and away from the side of health benefits, we, as physicians, … as the ones that have to speak up.”—Elisabeth Potter, a plastic surgeon in Austin, Texas, who specializes in breast reconstruction for cancer patients and recently spoke out against UnitedHealth Group

● “A lot of us have frustration [about Big Medicine], but we’re also trapped. I’m a pulmonary and critical care physician. I have to work in an ICU. I have to work in a hospital. I can’t go out on my own.”—Gabriel Bosslet, a pulmonary and critical care specialist in Indianapolis

● “Health care is too important … to allow [third parties] to essentially rent seek.”—Ben White, a neuroradiologist in Dallas who create a job board exclusively for truly independent, physician-owned practices

● “I have seen and experienced watching the care decline [following acquisition by HCA Healthcare, the largest health system in the country]—not because everyone’s not doing their best, but because there’s too much for one single person to do. … We have seen events, including some patient deaths, directly related to the staffing situation.”—Kerri Wilson, a registered nurse at Mission Hospital in Asheville, North Carolina, and a member of National Nurses United

We invite you to join us. Visit our website Breakupbigmedicine.com to sign up for more information and learn how you can participate. You can also watch our kickoff event, featuring Rep. Jake Auchincloss, FTC Commissioner Alvaro Bedoya, pharmacists, small business owners, and patient advocates.

We need to Break Up Big Medicine. It’s just what the doctor ordered.