Antitrust Regulation Enforcement in Health Care

Anokhi Manchanda

Associate Editor

Loyola University Chicago School of Law, JD 2025


Many Americans find the rising health care costs to be a cause for concern. The solution could be stronger antitrust enforcement, which would lead to more competition in the health care industry and, subsequently, lowered health care costs. In October 2023, Deputy Assistant Attorney General Andrew J. Forman spoke at the Capitol Forum’s health care competition conference in favor of antitrust enforcement in U.S. health care.


Current state of health care and competition issues


Currently, health care represents around 20% of the United States’ gross domestic product (GDP). Despite spending more than other high-income countries on health care, the life expectancy in the U.S. is the lowest of the ‘developed’ world. While some argue that health care cost, access, and quality are separate, it is important to see how they affect each other and are interconnected. This is one example where organizations, such as the Federal Trade Commission (FTC), must be up to date on their expertise in health care. The FTC conducts research and issues reports on competition issues such as product sales, mail order pharmacies, and economic analyses of mergers in the industry.


Arguments for antitrust enforcement


There are many arguments in favor of antitrust enforcement. Competition law can lead to lower costs because the laws prevent providers from meeting and agreeing to increase prices as a collective. These lower costs can enhance quality, as increased costs often cause people who cannot afford the raised prices to find substitutes for treatment or simply go without it. Additionally, companies in the industry itself do not disagree about the competitive issues in the health care field. They spend time blaming each other for the competitive issues, as seen in advertisement and lobbying campaigns. For example, drug companies blame pharmacy benefit managers (PBMs) for higher costs and less access of drugs and PBMs blame drug companies for the same. Similarly, providers blame insurance companies for increasing care costs and insurance companies blame providers for that same rise in costs.


Analyses relating to competition problems name the lack of competition as causing some of the issues. For example, a professor of public policy and business administration from Harvard stipulated that lack of competition causes quality of care to suffer, health care workers’ wage depression, and higher pricing. The higher pricing has been proven to be a direct result of provider consolidation. KFF, a non-profit, independent source for health policy research, stated that policy makers have proposed stronger antitrust regulation to combat rising health care costs, which will allow for care to be more affordable and even help reduce the number of adults with medical debt.


Arguments against antitrust enforcement


While the arguments for antitrust enforcement are generally not in dispute, there are some concerns from professionals in the industry. One fear that professionals have is that the antitrust enforcement may work for normal goods and services, but may not be adaptable to the specialized aspects of the medical industry. Specialized aspects include quality of care and that medical professionals self-govern their responsibilities. There is still concern, even though the Supreme Court has held that antitrust enforcement will be treated differently in the professional services industries than other industries. Furthermore, how the antitrust agencies apply their enforcement efforts is becoming increasingly more subject to pressures and demands by the government and consumers. The resulting efforts by antitrust agencies from this pressure is frustrating to medical professionals. Finally, it is pertinent to note that a byproduct of enforcing these antitrust and competition laws could very well be a major overhaul of the health care industry, with unknown results and potential problems.


The solution for a better future in healthcare


The solution of greater antitrust enforcement seems simple and obvious but is more difficult than meets the eye because of limited resources. It is important to prioritize limited investigative resources for antitrust enforcement because of the great need for affordable health care. In a country that claims to care about American lives, the medical costs for prescriptions, insurance, etc. contribute to crippling debt and an unreasonable burden on the average American. It appears that enforcing antitrust regulation in the health care field is a feasible and necessary option to protect the people in the U.S. so that they can afford to take care of their basic wellbeing.