Last Tuesday, the Heinz School of Information Systems and Public Policy released “American Health Care at a Crossroads: Increasing Competition or a Descent to Monopoly?'' Featuring Jonathan Canter, Assistant Attorney General of the U.S. Department of Justice's Antitrust Division.
The lecture began with an introduction by Martin Gaynor, a professor of economics and health policy at Carnegie Mellon University, who provided context for the current state of health care in the United States, with a particular focus on Pittsburgh.
“Pittsburgh is an example of the best and worst of American health care,” Gaynor said. The city boasts many skilled medical professionals, top institutions, and cutting-edge technology.
But Gaynor noted that the lack of competition in the health care market is driving up costs and limiting options for patients and providers, an issue that is emblematic of the broader healthcare system. did. Addressing these concerns is more important than ever, and Kanter's insights and current research may provide guidance on potential solutions.
After Gaynor's opening remarks and Governor Garrett's statement, Cantor took to the stage to reflect on his work in the Justice Department's antitrust division and outline important steps to improve the health care system.
“Across the country, in nearly every industry, we have heard deep-seated concerns about the growth and expansion of monopoly power and monopoly power across our nation and economy,” he began.
“This story remains surprisingly consistent: People want the opportunity to build a better life for themselves. …But too many people believe that the path to financial freedom is limited. , it feels shrinking, or worse, non-existent.”
Kanter recalled that nearly all of his conversations with Americans traced back to flaws in the health care system. He is working with patients who are struggling to afford long-prescribed drugs that are suddenly no longer covered by insurance, and doctors who are experiencing burnout after their role has shifted to battling corporate bureaucracy. I explained the nurses' dissatisfaction and the exorbitant out-of-pocket costs. All of these challenges limit Americans' ability to improve their lives, as many are forced to spend money on high deductibles, copays, and insurance premiums.
“This is a moral and ethical issue,” Kanter said. “The world's richest country should not let short-term profiteering get in the way of caring for the sick. … We must do better.”
Kanter discusses how the mounting challenges in the U.S. health care system have resulted from “a system that was supposed to introduce competition and efficiency” to become less competitive, less efficient, and more wasteful. We discussed.
While he acknowledged that antitrust enforcement alone cannot repair the health care system, he emphasized the important role of antitrust law in addressing the problem.
“Antitrust enforcement and competition policy are core tools and often the best tools to address problems arising from consolidation, anticompetitive behavior, and the emergence of disproportionately powerful companies,” he said. There is,” he said.
Kanter went on to discuss the “platformization” of healthcare, where large companies integrate across multiple levels of the healthcare ecosystem, including insurance, pharmacy, and provider networks.
“The physical distance between caregivers and patients is now miles apart, functionally, due to the proliferation of industry intermediaries who figuratively sit in exam rooms,” Kanter explains. and highlighted how these developments are separating patients from the affordable care they need.
He warned that these large healthcare platforms could lead to a “private single-payer” system controlled by a small number of companies without the transparency and accountability of government healthcare programs.
“Our market is at risk of tilting towards one or two major domestic platforms,” Kanter said.
To counter the growing concentration of power in the hands of a few companies, Canter proposed changing the way antitrust regulators approach health care.
“We need to move away from two-dimensional, Tetris-style analysis…This analysis is inadequate to address modern healthcare systems defined by large intermediary platforms,” he said.
Instead, he explores how integration across different levels of the health care system can lead to anticompetitive practices such as self-prioritization, steering patients toward affiliated providers, and creating barriers to entry into new industries. We advocated a comprehensive strategy to help regulators better understand. competitors.
“If we want health care to be a market-based industry, we have to invest in a healthy market environment, and that has to start with competition and choice,” Kanter said.
The stakes are high because the dominance of this system stifles innovation, increases costs, and erodes the independence of local health workers. Mr. Kanter concluded by stressing the need to adjust antitrust approaches before the system becomes irrevocably entrenched in the hands of a few dominant players.
“I foresee a not-too-distant future where several integrated healthcare platform stacks accumulate generational control over healthcare,” he said. “Almost 15 years later, we may be accelerating our march towards single payer, just not what everyone imagined in 2010 and not what everyone wants today. It's not like being there.”
Kanter's message was clear. It means “something needs to change.” “The time to have this discussion is now,” he concluded, his voice straining. “And the timing is urgent.” The future of the nation's health care system depends on it.
