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Illustration: Aïda Amer/Axios

NorthBay Healthcare, a not-for-profit hospital system in California, recently gave a candid look into how it operates, telling investors it has used its negotiating clout to extract "very lucrative contracts" from health insurance companies.

Why it matters: This is a living example of the economic theories and research that suggests hospitals will charge whatever they want if they have no or minimal competition.

Details: NorthBay owns two hospitals and several clinics in California's Solano County. Kaiser Permanente owns the only other full-service hospital in the county, and Sutter Health operates some medical offices. (A NorthBay spokesperson argued the system is "more akin to the David among two Goliaths.")

Three health insurers — Kaiser, Blue Shield of California and Anthem — have terminated their contracts with NorthBay over the past couple years. During a June 19 call with bondholders, executives explained why this has happened.

"We've been able to maintain very lucrative contracts without the competition. And what the payers are saying is, they would like us to be like 90% of the rest of the United States in terms of contract structure."
— Jim Strong, interim CFO, NorthBay Healthcare

Between the lines: NorthBay's revenue has increased by 50% over the past few years, from $400 million in 2013 to $600 million in 2018, due in large part to its natural monopoly and oligopoly over hospital services. This is exactly what we should expect to happen when sellers have the upper hand over buyers, economists say.

  • "As hospitals gain market power and as hospitals become the only game in town, they have an enormous amount of leverage against the insurers," said Sunita Desai, a health economist at NYU.

NorthBay also serves as a cautionary tale for price transparency, the latest health policy de jour.

  • "If the health care system is consolidated, consumers don't have anywhere else to go," Desai said. "Even if they see the prices of a given hospital, they're limited in terms of how much they can 'shop' across providers."

Flashback: "We find that nonprofit hospitals set higher prices when they have more market power all else being equal," federal antitrust regulators wrote in a 1996 study.

Go deeper

Federal judge blocks Biden's vaccine mandate for federal workers

President Biden speaking from Eisenhower Executive Office Building on Jan. 21. Photo: Yuri Gripas/Abaca/Bloomberg via Getty Images

A federal judge in Texas blocked the Biden administration from enforcing its coronavirus vaccine mandate for federal workers on Friday, citing the outcome of last week's Supreme Court ruling that nullified the administration's vaccine-or-test requirement for large employers.

Why it matters: It's a blow to President Biden's efforts to increase the U.S.' vaccination rates, though much of the federal workforce has already been vaccinated against the virus.

Updated 6 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.
  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
Updated 7 hours ago - Economy & Business

Janet Yellen co-opts Reaganomics phrase for new Davos speech

Treasury Secretary Janet Yellen at a speech this week. Photo: Alex Wong/Getty Images

The U.S. needs to focus on increasing its productive potential, Treasury Secretary Janet Yellen told world leaders Friday, calling for what she terms "modern supply side economics."

Why it matters: She co-opted a phrase traditionally used by political conservatives to describe low-tax and deregulatory policies — and framed the Biden administration's initiatives as the best path forward to achieve greater national prosperity.