Jun 10, 2019

The U.S. health care system is full of monopolies

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Data: Open Markets Institute; Chart: Axios Visuals

Even the behind-the-scenes parts of the health care industry are dominated by a small handful of companies — and critics say that drives up prices for everyone.

Why it matters: The U.S. spends more than any other industrialized country for health care, largely because our prices are higher. And the monopolies that support those high prices could undermine both liberal and conservative dreams of a more efficient system.

The big picture: This is a trend that's happening at every level.

  • Hospital systems continue to merge with each other and gobble up doctors’ practices, which lets them charge more for the care they provide.
  • Insurers and pharmacy benefit managers are also merging, and are now on track to bring in more revenue than the tech industry's biggest powerhouses.

Yes, and: That trend toward concentration extends throughout the system, even into sectors that most patients never directly interact with, according to new data from the Open Markets Institute, shared first with Axios.

  • As long as we’re talking about hospitals, for example, let’s look at their suppliers: One company controls 64% of the market for syringes, according to OMI’s data. Just 3 companies control 86% of the market for IV solution. Two companies make 47% of hospital beds.
  • None of those sectors is particularly huge — syringes are the biggest, with $3.8 billion in annual revenue. But in a system that’s already not very competitive, each step without competition feeds into the next one.

“America’s health care crisis is brought you by monopoly,” Open Markets policy director Phil Longman said.

Dialysis is a particularly stark example:

  • Dialysis clinics bring in about $25 billion per year in revenue. And 2 companies — Fresenius and DaVita — control 92% of that market.
  • Fresenius is the leader, with almost 50% market share.
  • The manufacture of dialysis supplies is also concentrated around 2 companies — one of which is Fresenius. It controls 33% of that market.

This level of concentration can pose a problem for both liberal and conservative policy proposals, Longman argues.

  • Conservatives, for example, wanted to shift dialysis away from VA facilities and let veterans use private care instead.
  • Especially in sparsely populated areas, there's an argument that such an arrangement would be more efficient, Longman said — but without actual competition in the private market, the VA just ends up paying more.
  • But by the same token, large hospital systems dominate some regions entirely. They’re not only the only source of care for miles, but also the largest employer and thus an important political constituency.
  • And that could make it hard for Democrats to follow through on big payment cuts in an expanded public program or "Medicare for All."
  • “What are the chances the taxpayers get a good price if we don’t fix the monopoly problem?"

Go deeper

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Photo: Stephen Maturen/Getty Images

Eight states plus D.C. are holding primary elections today following a week of intense protests across the country over the brutal police killing of George Floyd.

Why it matters: It's the first major test for voting since the national outcry. Concerns over civil unrest and the police — as well as the coronavirus and expanded absentee voting — could reduce the number of voters showing up in person but heighten tensions for those who do.

Axios-Ipsos poll: America’s big racial divide on police, virus

Data: Ipsos/Axios survey; Note: ±3.2% margin of error; Chart: Andrew Witherspoon/Axios

A new Axios-Ipsos poll finds that America has a massive racial gulf on each of our twin calamities — trust in police, and fear of the coronavirus.

  • 77% of whites say they trust local police, compared with just 36% of African Americans — one of many measures of a throbbing racial divide in Week 11 of the Axios-Ipsos Coronavirus Index, taken the week George Floyd was killed by a white policeman in Minneapolis.
Updated 54 mins ago - Politics & Policy

Updates: George Floyd protests nationwide

Police officers wearing riot gear push back demonstrators outside of the White House on Monday. Photo: Jose Luis Magana/AFP via Getty Images

Protests over the death of George Floyd and other police-related killings of black people continued for a seventh day across the U.S., with President Trump threatening on Monday to deploy the military if the unrest continues.

The latest: Four police officers were struck by gunfire while standing near a line in St Louis on Monday after a peaceful demonstration, Police Chief John Hayden said early Tuesday. They were all taken to hospital with non-life threatening injuries. He said a small group of people had thrown rocks and fireworks at police officers.