Antitrust

Dealing Boldly with Big Pharma

Three days after Donald Trump took office in 2017, the Pharmaceutical Research and Manufacturers of America trade association launched a multimillion campaign to bolster its image in the face of criticism from across the political spectrum of exorbitant drug price hikes. Under the banner of Go Boldly, PhRMA sought to persuade lawmakers and the public that biopharmaceutical producers were doing great things to improve our quality of life and were not just price-gouging crooks.

Two years later, the campaign is still in operation, apparently because the public has not been won over. That’s not surprising, given that Big Pharma is still behaving badly. Relieved that the Trump Administration’s drug cost initiative turned out to be toothless, major drug makers are implementing new rounds of price increases.

Promoting the idea that the industry is preoccupied with innovation is also being made more difficult by the announcement that Bristol-Myers Squibb is seeking to spend $74 billion to acquire rival Celgene. The deal would unite two companies that each have been struggling with their cancer treatments.

Bristol’s Opdivo drug has been losing ground to Merck’s Keytruda while Celgene has been experiencing setbacks in clinical trials and is facing a patent expiration in 2022 for its major product Revlimid. A marriage of the two companies would serve mainly as an excuse to eliminate jobs and raise prices, while doing little that would benefit patients.

The merger would also bring together two companies that have checkered legal and regulatory track records. According to Violation Tracker, Bristol has racked up nearly $1 billion in fines and settlements for a wide range of offenses. These include a $515 million settlement with the Justice Department of allegations relating to drug marketing and pricing; a $150 million settlement with the SEC concerning accounting fraud; a $14 million settlement of Foreign Corrupt Practices Act allegations; and a $3.6 million settlement of Clean Air Act violations.

It has also faced criminal charges, including one case in which it paid $300 million and got a deferred prosecution agreement to resolve allegations of accounting manipulation and another in which it pled guilty to lying to the federal government during an investigation of a secret agreement to thwart a generic competitor to its blood thinner Plavix.

For its part, Celgene paid $280 million in 2017 to resolve allegations that it promoted two cancer drugs for uses not approved by the Food and Drug Administration.

The prospect of one ethically challenged and market weakened drug company paying $74 billion to acquire another is emblematic of what is wrong with the U.S. pharmaceutical industry. It provides additional justification for aggressive reforms such as the bill introduced by Bernie Sanders and Ro Khanna that would allow the federal government to authorize generic alternatives to overpriced drug or the proposal by Elizabeth Warren and Jan Schakowsky that the federal government itself produce generic alternatives under certain circumstances.

If we want to Go Boldly, let’s do it with alternatives that empower patients not drugmakers.

The Benefits of Hubris

As customary restraints on corporations and high-level public officials increasingly fall by the wayside in Trump’s America, we may have to rely on the likelihood that their greed will cause them to go simply too far.

That’s what happened with Scott Pruitt at the EPA: he ultimately brought about his own undoing through his inability to limit his covetousness for things large and small. The unbridled pursuit of self-interest may yet bring about the downfall of other Administration figures such as Jared Kushner and Wilbur Ross.

In a remarkable development, overreach also appears to be dooming a major media merger: the audacious effort by Sinclair Broadcast to take over Tribune Media and achieve a virtual stranglehold over local television broadcasting in the United States.

Sinclair seemed to have it made. The company embraced Trump during the 2016 campaign and offered itself up as a propaganda arm of the new administration, hiring Trump crony Boris Epshteyn to produce unabashedly pro-MAGA commentaries that the company compelled its affiliates to air.

The acquisition of Tribune, announced in May 2017, would have given Sinclair an unprecedented share of the local TV market, yet it appeared that the deal would sail through the Federal Communications Commission now that the agency was headed by Trump-appointed regulatory zealot Ajit Pai. Among the rules Pai was eager to eliminate were those involving ownership limits.

Sinclair, however, overplayed its hand. Rather than rubber-stamping the deal, the FCC has just decided to refer it to an administrative law judge, a move that is widely expect to doom the merger.

The company gave the agency little choice when it engaged in a dubious maneuver in its proposal on how to satisfy remaining ownership rules. While claiming that it would divest 23 stations, Sinclair would actually retain operational control over those properties. The FCC’s order suggested that the company’s proposal may have included “misrepresentation or lack of candor.” Translation: Sinclair is a big fat liar.

An article in Politico, describing what it called “a tale of stunning hubris,” quoted a broadcast industry official as saying: “Sinclair’s style in Washington is Exhibit A of how to squander the most favorable regulatory environment in decades.”

While this is a major setback for Sinclair, the defeat of the merger is a boon for media diversity. It is also a hopeful sign amid the deregulatory onslaught and corporate empowerment that have marked so much of the first year and a half of the Trump Administration.

It would be preferable if public interest groups could defeat business abuses directly, but for now we may have to stand by and wait for corporate hubris to do the job for us.

Bayer and Monsanto: Another Dubious Chemical Industry Marriage

If the chemical industry spent as much time on product safety as it does on corporate restructuring, the world would be a healthier place. In 2015 DuPont spun off a bunch of its operations with tainted environmental and safety records into a new company called Chemours. Then DuPont engineered a merger with its longtime rival Dow Chemical, which had its own checkered history, to form DowDuPont. The combined company is now making more structural adjustments.

More changes are in the works in connection with the recently completed merger of German chemical giant Bayer and Monsanto. This is another case of a marriage between two highly controversial corporations.

Bayer was one of the German companies that combined in the 1920s to form IG Farben, which would go on to use slave labor during the Nazi period and was then split up after the Second World War. The largest of the resulting companies were Bayer, BASF and Hoechst (now part of Sanofi).

As Bayer has stepped up its U.S. involvement over the past two decades it has gotten embroiled in one scandal after another. In 1997 one of its subsidiaries based in New Jersey pled guilty to criminal price-fixing and had to pay a $50 million fine. In 2000 Bayer had to pay $14 million to the federal government and the states to settle allegations that it inflated prices on drugs sold to the Medicaid program. In 2001 it was accused of price-gouging on the antibiotic Cipro, which was then in high demand because of the anthrax scare. It later had to pay $257 million to settle a federal lawsuit on Cipro overcharging.

In 2003 documents emerged suggesting that Bayer was aware of serious safety problems with its cholesterol drug Baycol long before the medication was withdrawn from the market. In 2004 Bayer had to pay a $66 million fine in another criminal price-fixing case. A 2008 explosion at a Bayer pesticide plant in West Virginia that killed two workers led to regulatory penalties including a $5.6 million settlement with the EPA. A report found that management deficiencies played a significant role in creating the conditions that caused the explosion. Environmental and workplace safety fines have continued in recent years.

Monsanto, now absorbed into Bayer, was long one of the most hated corporations in the United States, due to the hardball tactics its employed in marketing genetically modified seeds and Roundup herbicides to farmers. It brought aggressive lawsuits against farmers accused of violating its patents. The company somehow managed to avoid antitrust charges, but in 2016 it was fined $80 million by the Securities and Exchange Commission for accounting violations relating to Roundup.

Bayer’s pursuit of Monsanto is part of its effort to brand itself as a life sciences company rather than merely a chemical producer. Its three main divisions are Crop Science, Pharmaceuticals and Consumer Health (the latter being what used to be known as over-the-counter medications such as aspirin, which Bayer is credited with inventing).

Of these, the most problematic is crop science. Bayer, along with DowDuPont and ChemChina (which bought Syngenta), increasingly dominate world markets for seeds, pesticides and related agribusiness products, giving them unprecedented control over the global food supply. This may give us a headache no amount of aspirin can relieve.

Bumble Bee CEO Gets Stung

Corporate critics, myself included, have long complained about the unwillingness of federal authorities to hold top executives personally responsible for illicit practices at the businesses they run. It was thus surprising but encouraging to learn that the Justice Department Antitrust Division has gotten a grand jury to return an indictment against the chief executive of Bumble Bee Foods for participating in a conspiracy to fix prices of packaged seafood sold in the United States.

The case against Christopher Lischewski comes in the wake of the prosecution of the company itself, which last year agreed to pay a criminal fine of $25 million, which under certain circumstances could rise to more than $80 million. The investigation has also ensnared several other individuals, including two at Bumble Bee, which is owned by the British private equity firm Lion Capital, and one at rival Star Kist.

We can hope that these cases are a sign that the Trump Administration’s Antitrust Division is taking its job seriously. Since Trump took office, the division has announced several large penalties against foreign banks such as France’s BNP Paribas for manipulation of currency markets, but this was the continuation of an investigation that began under Obama.

Some other Trump era cases have been pretty minor, such as the $409,342 fine imposed on an e-commerce company for fixing the price of promotional wristbands.

Price manipulation relating to consumer and industrial products is a perennial form of corporate misconduct. It is one of the main business offenses that regularly involves criminal charges and results in guilty pleas.

In Violation Tracker we document 241 Antitrust Division cases against corporations that resulted in more than $10 billion in penalties. Looking at the list, one is struck by the fact that so many of the defendants are foreign firms, including 11 of the dozen biggest fines.

This is not to say that U.S. companies don’t fix prices. Probably the most famous price-fixing case ever was the conspiracy to manipulate the electrical equipment market by the likes of General Electric and Westinghouse in the 1950s. U.S. agribusiness giant Archer Daniels Midland was at the center of a lysine price fixing scandal in the 1990s.

It may be that in recent years federal antitrust prosecutors have felt pressure not to go after domestic companies, or else that foreign corporations are emboldened by the pro-business climate in the U.S. to engage in more brazen behavior.

In any event, at a time of unprecedented concentration of ownership in many U.S. industries, there is bound to be plenty of price collusion going on that needs to be investigated.

Aetna’s Deception and the ACA Crisis

One of the decisive moments in the 2016 election campaign came last summer, when major insurance companies cut back their involvement in the Affordable Care Act exchanges after claiming they were losing money in the market. This was seized on by Trump and other Republicans to further denigrate the ACA and argue the need for repeal and replace.

Evidence has now emerged suggesting that the insurers’ claims were more of the lies that tainted the whole campaign and that those lies were motivated by an attempt to influence the federal government’s policy on mergers.

What was often overlooked during discussions of the health insurance industry last year was that the biggest concern of the major firms was the fate of their attempt to capture greater market share through giant acquisitions. Aetna was seeking to acquire Humana, and Anthem wanted to join forces with Cigna. The two proposed deals, worth about $85 billion, would reduce the number of major players to three (the other being UnitedHealth).

The Obama Administration and multiple states challenged the mergers, which ended up in court. Recently a federal district court judge sided with the Justice Department in the Aetna-Humana case; another judge is expected to rule soon on the Anthem-Cigna deal.

In his 158-page ruling on the Aetna matter, U.S. District Judge John D. Bates cited evidence indicating that the company’s decision to leave ACA exchanges in 17 counties in three states (Florida, Georgia and Missouri) was designed to “improve its litigation position.” In other words, its main reason for dropping out was not the profitability of those markets but rather the attempt to make it more likely that the Humana acquisition would be approved.

The opinion reveals (on p.125) that when Aetna met with officials at the Justice Department and the Department of Health and Human Services prior to the filing of the government’s complaint it “connected this lawsuit with its future participation in the exchanges” and threatened (p.126) to withdraw from those exchanges if the merger were not approved.

Also included in the opinion is an excerpt (p.127) from an e-mail in which Aetna CEO Mark Bertolini stated that “the administration has a very short memory, absolutely no loyalty and a very thin skin.” Asked in a deposition what he meant by that, Bertolini expressed resentment that the administration was opposing the merger despite Aetna’s role in supporting the ACA during the battle over its enactment.

The judge went on to cite (p.129) internal company e-mails in which, in the words of the opinion, “Aetna executives tried to conceal from discovery in this litigation the reasoning behind their recommendation to withdraw from the 17 complaint counties.” That effort was unsuccessful.

Overall, the court found that the exchange counties from which Aetna was withdrawing were a mix of profitable and unprofitable ones, thus undermining the claim that the move was purely a business decision.

While Aetna’s deception failed to sway the government or the lawsuit, it had a significant political impact amid a heated campaign. Now that the campaign is over and the ACA opponents prevailed, Aetna and the other insurance giants are staying silent as Republicans move to gut the law.

It’s unclear whether the firms expect the exchanges to survive in some form or they are rooting for a return to the old days of minimal regulation. In either event, it’s clear that companies like Aetna and Anthem are putting their desire for oligopolistic control above all else.

The (Price) Fix is In

Conventional economists and the policymakers who follow their advice continue to insist that the market is an inevitable force to which we must all pay homage. Belief in the power of the “invisible hand” is used to justify all manner of conservative policies, including resistance to living wage ordinances.

Yet there is plenty of evidence that influences other than supply and demand play a role in commercial activity, even when government is not involved. A key example concerns the setting of prices, which is supposedly the purest of free market activities but is frequently the result of collusion among supposed competitors.

Anyone who read Adam Smith in college may have been exposed to his observation that “people of the same trade seldom meet together even for merriment and diversion, but the conversation ends in a conspiracy against the public or some contrivance to raise prices.”

I was reminded of the enduring truth of that statement in the course of gathering data for the forthcoming expansion of the Violation Tracker database I oversee as part of my work for the Corporate Research Project of Good Jobs First. The bulk of that expansion will cover the many sins of the banking sector, but it will also include other commercial offenses such as price-fixing.

Since the beginning of 2010, the Antitrust Division of the Justice Department has resolved price-fixing cases against more than 80 companies. This is one of the few areas in which corporations routinely face criminal charges and usually have to enter guilty pleas rather than getting off with a deferred-prosecution or non-prosecution agreement.

Those 83 companies have had to pay a total of more than $4 billion in fines, with the individual amounts ranging as high as $500 million in the case of Taiwanese electronics company AU Optronics, which pleaded guilty to fixing prices of LCD displays used in computers and televisions in the United States. A federal jury found that the company conspired with its competitors during monthly meetings secretly held in hotel conference rooms, karaoke bars and tea rooms around Taiwan.

AU Optronics is one of five Taiwanese companies that have faced U.S. price-fixing charges in recent years, but the largest number of defendants in these cases come from Japan. Forty-nine Japanese companies have paid a total of $2.8 billion in penalties. Adding in the two defendants from South Korea and one from Singapore, Asian companies accounted for more than two-thirds of the cases and three-quarters of the penalties.

Price-fixing, however, is not an exclusively Asian proclivity. The list of defendants include 14 U.S. companies, seven from Germany, two from Switzerland and one each from Bermuda, Chile and Sweden.

The industry that has dominated U.S. price-fixing prosecutions in recent years is auto parts, which accounts for 42 defendants that have paid some $2.6 billion in penalties. More defendants come from the freight industry but the average penalties have been lower, totaling $449 million. The electronic components sector accounts for $583 million, mainly as a result of AU Optronics.

While many of the culprits are lesser known manufacturing and service companies, the list also includes corporations familiar to consumers. Among these are Bridgestone, Panasonic and Samsung.

Keep these cases in mind the next time someone insists that the market is sacrosanct

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Note: Violation Tracker 2.0 — which will add banking offenses, money-laundering, defrauding of consumers, foreign bribery and export-control/sanctions violations as well as price-fixing — is scheduled to be released on June 28.

Monsanto’s German Suitor Has Its Own Tainted Record

Monsanto, one of the most controversial corporations in the United States, now finds itself the target of a takeover campaign by German pharmaceutical and chemical giant Bayer. Would a change in ownership improve the behavior of the biotechnology company dubbed “Mutanto” by its critics?

Answering that question requires a look at Bayer’s own track record, which is far from unblemished. Most Americans associate Bayer with aspirin. The company created the analgesic in 1899, but during World War I the U.S. government seized Bayer’s American assets and allowed other firms to sell aspirin under the Bayer name until the German company bought back the rights in 1994.

In the 1920s Bayer was absorbed into the massive IG Farben cartel, which used slave labor and supported the Nazi regime. After the Second World War it re-emerged as one of the companies created through the break-up of IG Farben. During the 1950s it began to return to the U.S. market through efforts such as a joint venture with Monsanto (in its pre-agribusiness era) called Mobay Chemical.

That’s just the quick version of Bayer’s controversies. For more see the website of the Coalition against BAYER-dangers, a German watchdog group that has been monitoring the company for more than 30 years.

Perhaps most troubling is the fact that Bayer has already been active in the businesses in which Monsanto has gained its checkered reputation: agricultural chemicals and genetically modified seeds. Before the Monsanto bid, Bayer was in the news most often because of concerns that its pesticides were responsible for sharp drops in bee populations.

The chances that a Bayer takeover of Monsanto will get the U.S. company to clean up its act seem slim indeed. In fact, the combined company will probably be an even bigger threat.

The 2015 Corporate Rap Sheet

The ongoing corporate crime wave showed no signs of abating in 2015. BP paid a record $20 billion to settle the remaining civil charges relating to the Deepwater Horizon disaster (on top of the $4 billion in previous criminal penalties), and Volkswagen is facing perhaps even greater liability in connection with its scheme to evade emission standards.

Other automakers and suppliers were hit with large penalties for safety violations, including a $900 million fine (and deferred criminal prosecution) for General Motors, a record civil penalty of $200 million for Japanese airbag maker Takata, penalties of $105 million and $70 million for Fiat Chrysler, and $70 million for Honda.

Major banks continued to pay large penalties to resolve a variety of legal entanglements. Five banks (Citigroup, JPMorgan Chase, Barclays, Royal Bank of Scotland and UBS) had to pay a total of $2.5 billion to the Justice Department and $1.8 billion to the Federal Reserve in connection with charges that they conspired to manipulate foreign exchange markets. The DOJ case was unusual in that the banks had to enter guilty pleas, but it is unclear that this hampered their ability to conduct business as usual.

Anadarko Petroleum agreed to pay more than $5 billion to resolve charges relating to toxic dumping by Kerr-McGee, which was acquired by Anadarko in 2006. In another major environmental case, fertilizer company Mosaic agreed to resolve hazardous waste allegations at eight facilities by creating a $630 million trust fund and spending $170 million on mitigation projects.

These examples and the additional ones below were assembled with the help of Violation Tracker, the new database of corporate misconduct my colleagues and I at the Corporate Research Project of Good Jobs First introduced this year. The database currently covers environmental, health and safety cases from 13 federal agencies, but we will be adding other violation categories in 2016.

Deceptive financial practices. The Consumer Financial Protection Bureau fined Citibank $700 million for the deceptive marketing of credit card add-on products.

Cheating depositors. Citizens Bank was fined $18.5 million by the CFPB for pocketing the difference when customers mistakenly filled out deposit slips for amounts lower than the sums actually transferred.

Overcharging customers. An investigation by officials in New York City found that pre-packaged products at Whole Foods had mislabeled weights, resulting in grossly inflated unit prices.

Food contamination. In a rare financial penalty in a food safety case, a subsidiary of ConAgra was fined $11.2 million for distributing salmonella-tainted peanut butter.

Adulterated medication. Johnson & Johnson subsidiary McNeill-PPC entered a guilty plea and paid $25 million in fines and forfeiture in connection with charges that it sold adulterated children’s over-the-counter medications.

Illegal marketing. Sanofi subsidiary Genzyme Corporation entered into a deferred prosecution agreement and paid a penalty of $32.6 million in connection with charges that it promoted its Seprafilm devices for uses not approved as safe by the Food and Drug Administration.

Failure to report safety defects. Among the companies hit this year with civil penalties by the Consumer Product Safety Commission for failing to promptly report safety hazards were: General Electric ($3.5 million fine), Office Depot ($3.4 million) and LG Electronics ($1.8 million).

Workplace hazards. Tuna producer Bumble Bee agreed to pay $6 million to settle state charges that it willfully violated worker safety rules in connection with the death of an employee who was trapped in an industrial oven at the company’s plant in Southern California.

Sanctions violations. Deutsche Bank was fined $258 million for violations in connection with transactions on behalf of countries (such as Iran and Syria) and entities subject to U.S. economic sanctions.

Air pollution. Glass manufacturer Guardian Industries settled Clean Air Act violations brought by the EPA by agreeing to spend $70 million on new emission controls.

Ocean dumping. An Italian company called Carbofin was hit with a $2.75 million criminal fine for falsifying its records to hide the fact that it was using a device known as a “magic hose” to dispose of sludge, waste oil and oil-contaminated bilge water directly into the sea rather than using required pollution prevention equipment.

Climate denial. The New York Attorney General is investigating whether Exxon Mobil deliberately deceived shareholders and the public about the risks of climate change.

False claims. Millennium Health agreed to pay $256 million to resolve allegations that it billed Medicare, Medicaid and other federal health programs for unnecessary tests.

Illegal lobbying. Lockheed Martin paid $4.7 million to settle charges that it illegally used government money to lobby federal officials for an extension of its contract to run the Sandia nuclear weapons lab.

Price-fixing. German auto parts maker Robert Bosch was fined $57.8 million after pleading guilty to Justice Department charges of conspiring to fix prices and rig bids for spark plugs, oxygen sensors and starter motors sold to automakers in the United States and elsewhere.

Foreign bribery. Goodyear Tire & Rubber paid $16 million to resolve Securities and Exchange Commission allegations that company subsidiaries paid bribes to obtain sales in Kenya and Angola.

Wage theft. Oilfield services company Halliburton paid $18 million to resolve Labor Department allegations that it improperly categorized more than 1,000 workers to deny them overtime pay.

Same-Industry Marriages

mergers Same-sex unions are not the only kind of marriage on the rise. In the business world, same-industry combinations are happening at breakneck speed as large corporations join with their rivals.

The same-industry marriages that will probably affect the largest number of people are those being proposed in the health insurance industry, where Aetna is seeking to buy Humana, and Anthem (formerly known as Wellpoint) is playing the mating game with Cigna, though UnitedHealth may get in on the act. Additional concentration does not bode well for keeping insurance premiums under control.

There’s a lot more going on. This was driven home to me recently while I was updating the parent-subsidiary linkages in the Subsidy Tracker database I oversee in my role as research director of Good Jobs First. I had to make adjustments relating to dozens of recently completed mergers.

Among these are the combination of Heinz and Kraft Foods arranged by Warren Buffett and the Brazilian investment firm 3G Capital, the union of deep-discount chains Dollar Tree and Family Dollar, and the merger of packaging giants MeadWestvaco and Rock-Tenn into a combined firm called WestRock.

An interesting trend is increasing German control over what remains of the U.S. industrial sector. Siemens recently completed its purchase of the industrial equipment firm Dresser-Rand, and ZF Friedrichshafen acquired TRW Automotive.

Other deals still in the pipeline include Staples’ bid for Office Depot, Expedia’s plan to acquire Orbitz (after gobbling up Travelocity), Monsanto’s offer for Syngenta, and AT&T’s plan to buy Dish Network, which in the meantime is looking to acquire T-Mobile.

Thanks to all this activity, 2015 could set a new record for M&A activity. Along with the economic benefit of consolidation, large companies are taking advantage of the mostly lax regulatory climate. Business apologists complain when the occasional deal — such as the attempted mergers of Sysco and US Foods, and Comcast and Time Warner Cable — is blocked, but the fact is that a large portion of proposed combinations face little opposition. And when regulators do protest, they can often been placated with relatively minor concessions, such as the requirement that Dollar Tree sell off only 330 out of the more than 8,000 outlets in the Family Dollar chain.

These corporate combinations are all about profit. In a country that claims to revere free competition, large corporations tend to move in the opposite direction: they want to control markets. While human marriages, as Justice Kennedy put it, are all about dignity, these business unions are about power and are thus one kind of marriage we should not be celebrating.

Dual Perils Confront the ACA

scylla-and-charybdis-bookpalace The Affordable Care Act is a Rube Goldberg-like contraption based on both private-sector competition and government subsidies. Both of those elements are in danger of collapse.

The disappearance of the federal subsidies that enable millions of lower-income people to purchase the coverage they are now required to have is, of course, a possible outcome of an imminent Supreme Court ruling. It is mind-boggling that the King v. Burwell case, a brazen effort by diehard Obamacare opponents to exploit an obvious drafting error in the ACA, has gone this far and might actually succeed. It says a lot about the mangled state of public policy in this country that we see a front-page story in the New York Times about the growing panic among conservatives that they might win and be held responsible for the ensuing chaos. Apparently, they forgot there is a difference between taking meaningless votes in the House and bringing a case to a high court with a significant contingent of Justices inclined to take ideological posturing seriously.

Also at risk is the system in which private insurance carriers are supposed to compete against one another to provide coverage in the exchanges to their expanded pool of captive customers. In many places, that competition was not very robust to begin with, but now it may become even more diminished.

According to reports in the business press, the biggest for-profit health insurance companies are looking to gobble up their slightly smaller rivals. The Wall Street Journal says UnitedHealth Group has its eye on Aetna, which in turn is said to be exploring some form of cooperation with Humana, whose success in selling supplementary insurance to Medicare enrollees is attractive. At the same time, the Journal reports, Anthem has been in negotiations with Cigna, which is also said to be talking to Humana.

We can see where all this is going. Unless antitrust regulators show some backbone, the current private health insurance oligopoly could turn into a duopoly. The non-profit portion of the market does not provide much help. The 37 independently owned companies that make up the Blue Cross and Blue Shield network are increasingly inclined to divvy up markets and avoid competing with one another, according to lawsuits now pending in federal court. The litigation charges that the behavior of the Blues, some of which are controlled by for-profits such as Anthem, is driving up premium costs for customers while at the same time pushing down payment rates for physicians and other healthcare providers. These predatory practices threaten both the ACA and traditional employer-provided plans.

In the eyes of the Administration, the big insurers are the good guys. Initially suspicious of the ACA, the companies came to accept the law and even turned into major boosters. They embraced ACA’s Medicaid expansion component, seeing opportunities for managed care business in some states, and supported the Administration’s position in King v. Burwell. A SCOTUS ruling in the other direction would take a big hit on their soaring stock prices.

That’s where mainstream healthcare reform has left us — caught between predatory insurance providers on the one side and nihilistic ideologues on the other.