Former DOJ Officials Call for Antitrust Scrutiny of Health Care Conglomerates’ Concerning Practices

In recent years, the growing influence of large technology platforms has attracted significant scrutiny from regulators and policymakers worldwide. However, this focus on “big tech” may overlook a parallel and equally concerning consolidation occurring in the health care sector, where a handful of mammoth conglomerates are reshaping the landscape. An insightful new opinion piece coauthored by two former officials of the U.S. Department of Justice’s antitrust division sheds light on this emerging phenomenon, arguing that the rise of integrated health care platforms mirrors many of the problematic characteristics historically associated with big tech companies. Their urgent call for rigorous antitrust enforcement aims to preempt further market concentration that threatens competition, innovation, and affordable care.

The authors, Martin Gaynor, an economist and professor at Carnegie Mellon University’s Heinz College, and Jonathan Kanter, a former assistant attorney general specializing in antitrust law, articulate a clear narrative of transformation in the U.S. health care system. Unlike the traditionally fragmented health care market comprising insurers, pharmacies, physician groups, home health providers, and hospitals operating semi-independently, the current trend is toward vertically and horizontally integrated entities dominating multiple facets of care delivery, insurance, data analytics, and pharmacy management. These “big health care” platforms, exemplified by corporate giants such as UnitedHealth and CVS Health, consolidate various services under centralized ownership, effectively replicating the ecosystem control seen in major technology platforms.

Central to this phenomenon is the “platformization” of health care, a process by which firms expand their influence not just across one or two segments, but across the entire health care continuum. This consolidation is facilitated by an ongoing merger and acquisition spree that allows companies to amalgamate assets and services, creating multilayered networks with significant market power. The authors emphasize that this structural shift perpetuates several pernicious effects, disrupting competitive dynamics, erecting barriers to entry for smaller players, and exacerbating conflicts of interest that complicate regulatory oversight.

One of the most troubling consequences of these sprawling platforms is the reduction in market competition. Once numerous independent providers and small firms populated the health care ecosystem, offering a diversity of options and fostering innovation. Now, dominant platforms wield their scale to undercut competitors, marginalize independent practitioners, and shape market conditions according to their strategic interests. This concentration not only stifles competition but also threatens patients’ access to care by limiting alternatives and fortifying monopolistic power in regional health care markets.

The economic implications of such concentrated platforms are equally dire. Drawing on decades of empirical research and government investigations, Gaynor and Kanter highlight that consolidation within health care has not yielded the promised benefits of lower costs, improved quality, or increased efficiency. On the contrary, cumulative mergers and acquisitions have frequently resulted in higher prices and elevated spending on care, with little to no measurable gains in population health outcomes. This trend challenges conventional wisdom that larger scale inherently drives better resource utilization or innovation in health care delivery.

Furthermore, platformization introduces significant regulatory challenges. By operating across diverse market segments—insurance, care provision, pharmacies, and data management—large health care conglomerates can exploit regulatory arbitrage opportunities. Their integrated structures allow for strategic maneuvering around existing rules designed for siloed entities, increasing the risk of conflicts of interest and reducing transparency. The authors warn that this may enable practices that prioritize corporate profitability over patients’ welfare, further consolidating market power and entrenching systemic inefficiencies.

At the physician and provider level, the dominance of these platforms often undermines the viability of small businesses and independent practitioners. Many health care professionals find themselves squeezed by contractual pressures, reduced reimbursement rates, and constrained referral networks dictated by platform owners. This dynamic not only threatens livelihoods but also diminishes the diversity of care models and innovations that typically emerge in a more decentralized health care environment.

From an innovation standpoint, such consolidation poses profound risks. The homogeneity and scale of these platforms could dampen incentives for novel approaches to organizing and delivering care. Historically, smaller providers and startups have been fertile ground for experimental, patient-centered solutions. However, the competitive and financial pressures exerted by dominant platforms may discourage risk-taking and marginalize innovative entrants, potentially slowing advances in medical treatments, preventive care, and health technology integration.

The authors’ perspective comes at a critical juncture, which they describe as an inflection point for the U.S. health care system. If current trends continue unchecked, a handful of integrated platforms could solidify their grip on the entire health care ecosystem. This consolidation would exacerbate existing challenges, making health care more expensive, less responsive, and harder to access for millions of Americans. Recognizing this looming threat, the authors urge policymakers, regulators, and stakeholders to look beyond individual component services and address the structural conditions enabling this concentration.

Importantly, Gaynor and Kanter emphasize that antitrust enforcement is not merely a policy option but a necessity to restore competitive balance. They advocate for vigorous legal action against anticompetitive behaviors and structural remedies, including the possibility of breaking up dominant platforms, to dismantle excessive market power. Their call underscores the need for proactive measures before the market becomes too concentrated for meaningful intervention.

The article contributes to a growing discourse on the parallels between big tech and big health care, suggesting that lessons from antitrust scrutiny in the technology sector can inform strategies to safeguard competitive health care markets. However, health care’s unique complexities and regulatory environment necessitate tailored approaches that account for its multifaceted operations, patient impacts, and social importance.

In summary, the rise of health care platforms demands urgent attention. As these conglomerates consolidate control over insurance, care delivery, pharmaceuticals, and data analytics, they reshape market dynamics in ways that risk harming consumers, providers, and the broader health ecosystem. Without decisive policy responses and enforcement mechanisms, the U.S. health care system faces the prospect of entrenched monopolies that stifle competition, innovation, and access, ultimately compromising health outcomes and economic sustainability. The insights presented by Gaynor and Kanter provide a timely and compelling framework for evaluating these challenges and charting a path forward.

News Publication Date: 9-Apr-2025

Web References:
https://jamanetwork.com/journals/jama/fullarticle/2832535
http://dx.doi.org/10.1001/jama.2025.3641