Big Medicine is getting rich
off our sick healthcare system.
It’s time to break up these too-big-to-care monopolies and restore power to patients and healthcare workers
THE
Symptoms
For decades, federal policymakers in both parties have touted corporate consolidation and privatization.
As a result, the U.S. healthcare system today is at the mercy of monopolistic insurance conglomerates and middlemen, like pharmacy benefit managers (PBMs), which wield their market power to gouge patients, workers, taxpayers, employers, independent pharmacists, and unions. They also steer patients to their own subsidiaries, squeeze independent medical practices and pharmacies out of business, and game federal regulations designed to cap profits.
In short, vertically-integrated monopolies – like other plagues on the U.S. healthcare system: Big Pharma patent abuse, mega hospital mergers, and private equity ownership – exploit conflicts of interest to drive costs up and quality down.
THE
Diagnosis
UnitedHealth Group, for example, is the nation’s:
Largest commercial insurer;
Largest Medicare Advantage plan provider;
Largest physician employer;
Largest processor of health insurance claims through its clearinghouse;
Second-largest health savings account provider through its bank;
Third-largest PBM; and
Fourth-largest pharmacy operator (mail order and specialty).
United’s vertically-integrated business model is not unique. Other insurers (like CVS Health, Cigna Group, and Elevance Health) and middlemen (like McKesson, Cencora, and Cardinal Health) have followed in its extremely lucrative footsteps.
In fact, Big Medicine makes up at least seven of the Fortune 20 companies. Another four manage huge healthcare business: Walmart, Amazon, and Costco operate their own PBMs and pharmacies; Amazon and Costco also provide healthcare services; and Berkshire Hathaway insures healthcare providers and health insurers.
But Big Medicine profits at the expense of patients, whose outcomes continue to decline, and affordability, as healthcare spending approaches 20% of the GDP – or more than $14,500 per person annually.
Your health insurance company is not just your health insurance company.
Big Medicine likely owns the physician practice where you seek care, the PBM that determines which drugs you’re prescribed and how much you pay for them, the private label distributing those drugs, the pharmacy fulfilling your prescriptions, and other entities along the healthcare supply chain.
Dark blue: Big Medicine
Light blue: Big Medicine-adjacent
THE
TREATMENT PLAN
Drawing from the antimonopoly playbook, policymakers can lower costs, improve quality, and eliminate conflicts of interest by structurally separating Big Medicine’s business lines
There’s precedent for this: During the New Deal era, Congress passed the Glass-Steagall Act, which structurally separated commercial and investment banks given the systemic risks inherent to their common ownership.
A Glass-Steagall for health care would similarly place an iron curtain between PBMs and pharmacies, insurance companies and healthcare workers, wholesale drug distributors and specialty physician practices, and insurers and middlemen.
Doing so would restore the checks and balances necessary for an efficient healthcare system, one in which healthcare workers – not insurance companies, PBMs, or wholesalers – make treatment decisions based on medical judgment rather than profit motive; independent medical practices and pharmacies can compete; and patients and health plan sponsors, like employers and unions, can make informed choices, unswayed by unscrupulous brokers or false advertising.
Pharmacy benefit managers (PBMs)
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pharmacies
Insurance companies
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healthcare professionals
Wholesale drug distributors
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specialty physician practices
Insurers
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Middlemen
Breaking up these vertically integrated giants will eliminate the structural conflicts of interest that drive up costs and lower quality of care.
WHAT ABOUT
BIG PHARMA?
Big Pharma is responsible for out-of-control prescription drug costs and part of the Big Medicine problem, too.
While fully reining in Big Pharma’s power requires its own suite of policy reforms, a Glass-Steagall Act for health care would be a good start by restoring PBMs to their original role, negotiating lower prices on behalf of health insurers with drug manufacturers.
In recent decades, PBMs have consolidated and vertically integrated with insurers, warping their incentives such that they now favor higher prices; unwinding these mergers will reestablish PBMs as a counterweight to – rather than co-conspirator with – Big Pharma.
WHY
NOW?
Big Medicine has driven us to a breaking point.
Doctors are pulled away from patient care – sometimes from the literal operating table – by UnitedHealth Group and other insurance conglomerates seeking new reasons to deny coverage.
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.
More than one third of Americans live in healthcare deserts, largely because insatiable insurer greed has driven independent medical practices and pharmacies out of business.
Employers and unions are being crushed by ever-increasing premium costs, which further cut into workers’ wages.
And all of us live in fear that one illness could destroy our physical and financial health. If you’re a patient, nurse, doctor, employer, pharmacist, or American fed up with the current state of affairs, join us in demanding a break up of Big Medicine now - before it kills us.