Last Tuesday, the Heinz College of Information Systems and Public Policy presented “U.S. Healthcare at a Crossroads: Greater Competition or a Descent into Monopoly?” featuring Assistant Attorney General of the U.S. Department of Justice’s Antitrust Division Jonathan Kanter.
The lecture began with an introduction from Martin Gaynor, a professor of economics and health policy at Carnegie Mellon, who contextualized the current state of U.S. healthcare, with a particular focus on Pittsburgh.
“Pittsburgh exemplifies the best and the worst of U.S. healthcare,” Gaynor said. The city boasts many skilled healthcare professionals, the best institutions, and state-of-the-art technology.
However, Gaynor noted that the lack of competition in the healthcare market drives up costs and restricts options for patients and providers — issues emblematic of the wider institutions. Addressing these concerns is more critical than ever, and Kanter’s insights and current work may offer guidance on potential solutions.
After Gaynor’s opening remarks and a statement from Provost Garrett, Kanter took the podium to reflect on his work at the Department of Justice’s antitrust division and outline key steps for improving the healthcare system.
“Throughout the country, I’ve heard deep seated concern about the growth and expansion of monopoly power and monopsony power across our country and economy in nearly every corner of our nation, in nearly every industry,” he began.
“The story remains startlingly consistent. People want the opportunity to build better lives for themselves. … However, too many people find that pathways to economic freedom are limited, shrinking, or worse, nonexistent.”
Kanter recalled how nearly every conversation he has with concerned Americans circles back to the healthcare system’s flaws. He described patients struggling to afford long-prescribed medications that are suddenly excluded from coverage, the frustrations of doctors and nurses that burnout as their roles shift toward battling corporate bureaucracy, and exorbitant out-of-pocket costs. All of those challenges limit Americans’ ability to improve their lives, as many are forced to spend their money on high deductibles, co-pays, and premiums.
“This is a moral and ethical problem,” Kanter said. “The wealthiest country in the world should not let short-term profiteering get in the way of caring for the sick. … .We must do better.”
Kanter discussed how mounting challenges in the U.S. healthcare system are the result of “a system that was supposed to introduce competition and efficiency” becoming less competitive, less efficient, and more wasteful.
While he acknowledged that antitrust enforcement alone cannot fix the healthcare system, he emphasized its essential role in addressing its issues.
“Antitrust enforcement and competition policy are core tools, often the best tools to address problems that flow from consolidation, anti-competitive conduct, and the emergence of increasingly disproportionately powerful players,” he said.
Kanter went on to describe the “platformization” of healthcare, where large corporations integrate across multiple levels of the healthcare ecosystem — insurance, pharmacies, and provider networks.
“The physical distance between the caregiver and the patient … is functionally now miles away due to the pervasive thicket of industry middlemen that figuratively sit in the examining room,” Kanter explained, highlighting how these developments have distanced patients from the affordable care they need.
He warned that these massive healthcare platforms could result in a “private single-payer” system, controlled by a few corporations without the transparency or accountability of government health programs.
“We are at risk of our markets tipping to one or two major national platforms,” Kanter said.
To combat the increasing concentration of power in the hands of a few corporations, Kanter suggested a shift in how antitrust regulators approach healthcare.
“We need to break free from a two-dimensional Tetris-style analysis … which is ill-equipped to address a modern healthcare system defined by massive intermediation platforms,” he said.
Instead, he advocated for a comprehensive strategy that allows regulators to better understand how consolidation across the different levels of the healthcare system leads to anti-competitive practices, such as self-preferencing, steering patients toward affiliated providers, and creating entry barriers for new industry competitors.
“If we want health care to be a market-based industry, then we must invest in healthy market conditions, which must start with competition and choice,” Kanter said.
The stakes are high as the dominance of this system stifles innovation, raises costs, and erodes the independence of local healthcare practitioners. Kanter closed by emphasizing the need to adjust antitrust approaches before the system becomes irreversibly entrenched in the hands of a few dominant players.
“I foresee a not-so-distant future where a few integrated healthcare platform stacks will amass a generational hold over health care,” he said. “Nearly 15 years later, we may well be accelerating the march to single payer, just not the kind that anyone imagined in 2010 or not the kind that anyone wants today.”
Kanter’s message was clear: Something needs to change. “The moment for this discussion is now,” he concluded, his voice firm with urgency, “and the timing is urgent.” The future of the nation’s healthcare system depends on it.
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