Breaking up hospital and drug monopolies could save families $6,000 a year, report finds

The American Economic Liberties Project released a healthcare agenda on August 27 projecting that breaking up consolidated hospital, insurance and pharmacy benefit systems could save American households more than $6,000 a year, according to the group’s press release. The report, titled “Break Up Big Medicine,” estimates the changes it recommends would free up roughly $795 billion a year across the health care system.

The agenda was written for the Break Up Big Medicine coalition, a group of 26 organizations that launched in June and includes independent pharmacists, physicians, small business owners, patients, academics and policy groups. It points to consolidation as a driver of physician and drug shortages, longer wait times, growing “care deserts,” and higher rates of insurance denials, and notes that the United States spends roughly $15,000 per person on health care a year while lagging peer nations on life expectancy and maternal health outcomes. Employer-sponsored family insurance premiums have nearly tripled since 2005, the group says.

A separate analysis published by Families USA in May, “Big Systems, Bigger Profits: National Hospital Pricing Analysis,” found that in 42 states and the District of Columbia, five or fewer hospital systems controlled at least half of all hospital care in 2023. In 22 states and the District of Columbia, just three systems delivered more than half of all hospital care, according to the Families USA report.

The Economic Liberties agenda lays out four categories of changes. The first would bar insurers, pharmacy benefit managers and private equity firms from owning medical practices and pharmacies outright. The second would cap health care and prescription drug prices, expand public insurance options, ban delays caused by prior authorization requirements, and reduce out-of-pocket costs. The third calls for support for independent practitioners, an expanded physician workforce, a ban on noncompete agreements for health workers, and investment in rebuilding domestic drug manufacturing. The fourth would strengthen antitrust enforcement, close loopholes used by pharmaceutical manufacturers, and ban spread pricing and patent abuse.

“For decades, health care reform has focused on expanding private coverage and putting more money into a broken system while allowing corporate giants to consolidate power and drive up costs,” said Emma Freer, the group’s senior policy analyst for health care, in the release. Morgan Harper, the group’s director of policy and advocacy, said in the same release that “the health care crisis didn’t happen by accident, it is the direct result of decades of neoliberal policy choices that handed more power to corporate health care giants while families paid the price.”

The release also cites polling commissioned by the group finding that 71 percent of voters support breaking up large health care conglomerates, including 75 percent of Democrats and 70 percent of Republicans. Eighty percent of respondents, including 79 percent of Republicans, said hospital systems have too much control over the health care system.

The full report carries the title “Break Up Big Medicine: An Agenda to Restore Power Over the U.S. Health Care System to Patients and Practitioners While Saving Families More Than $6,000 a Year.” It is the coalition’s first joint policy agenda since its members, who include independent pharmacists, physicians, small business owners, patients, academics and policy organizations, launched the Break Up Big Medicine campaign in June.