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Expand chart
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

The hard math behind America's labor shortage

Data: Bureau of Labor Statistics, Congressional Budget Office; Chart: Axios Visuals

Yes, the pandemic has created unusual temporary labor market dynamics. But in the bigger picture, the 2010s were a golden age for companies seeking cheap labor. The 2020s are not.

The big picture: In the 2010s, the massive millennial generation was entering the workforce, the massive baby bo0m generation was still hard at work, and there was a multi-year hangover from the deep recession caused by the global financial crisis.

Advocates fret Roe v. Wade's 49th anniversary could be its last

Photo: Leigh Vogel/Getty Images for Women's March Inc

As Saturday marks the 49th anniversary of Roe v. Wade, the Supreme Court's landmark decision that legalized abortion access in the U.S., advocates warn the ruling is "more at risk now than ever."

The big picture: The Supreme Court in December heard a challenge to a Mississippi 15-week abortion ban that could throw Roe's survival into question, or at least narrow its scope.

Updated 12 hours ago - Politics & Policy

Omicron dashboard

Illustration: Brendan Lynch/Axios

  1. Health: Pfizer and Moderna boosters overwhelmingly prevent Omicron hospitalizations, CDC finds — Omicron pushes COVID deaths toward 2,000 per day — The pandemic-proof health care giant.
  2. Vaccines: The case for Operation Warp Speed 2.0 — Starbucks drops worker vaccine or test requirement after SCOTUS ruling — Kids' COVID vaccination rates are particularly low in rural America.
  3. Politics: Biden concedes U.S. should have done more testing — Arizona says it "will not be intimidated" by Biden on anti-mask school policies — Federal judge blocks Biden's vaccine mandate for federal workers.
  4. World: American Airlines flight to London forced to turn around over mask dispute — WHO: COVID health emergency could end this year — Greece imposes vaccine mandate for people 60 and older — Austria approves COVID vaccine mandate for adults.
  5. Variant tracker

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