Smash the Healthcare Monopolies!

1. Hospital System Monopolies

Current Concentration:

• Top 10 Hospital Systems: Control 25% of hospitals
• Examples:
  • HCA Healthcare: 182 hospitals, $60B revenue, and 290k employees
  • CommonSpirit Health: 142 hospitals and $33B revenue
  • Ascension: 140 hospitals and $28B revenue
  • Tenet Healthcare: 65 hospitals and $20B revenue

Violations:

• Revenue Caps: HCA = $60B (over $50B cap)
• Market Share: Many cities have 1-2 hospital systems (monopoly)
• Anti-Competitive Practices: Buy up competitors and raise prices

2. Break Up the Hospital Monopolies

Mandatory Breakup:

HCA Healthcare → 20 Regional Hospital Systems:

• 182 Hospitals / 20 = ~9 hospitals per system
• Each System: <$3B revenue, regional service area

All Major Systems Are Broken Up Similarly

Nationalize or Worker Cooperative?

Option A: Public Hospitals (Preferred for Essential Services):

• Government Owns the Hospitals: Federal, state, or municipal
• Doctors, Nurses, and Staff = Public Employees: Like VA hospitals, but for everyone
• Benefits:
  • Universal access (no profit motive for denying care)
  • Integrated with Medicare for All (same payer, same provider)
  • Stable funding (not dependent on patient volume)

Example: VA Healthcare

• Veterans Affairs Hospitals: Government-owned, government-staffed
• Quality: Equal or better than private hospitals (contrary to propaganda)
• Cost: 30% cheaper than private
• Expand Model: All hospitals become like VA (but for everyone)

Option B: Worker-Owned Hospital Cooperatives:

• Doctors, Nurses, and Staff Own the Hospital: Democratic governance
• Advantages:
  • Worker control over conditions, standards
  • Patient-centered (not profit-centered)
• Disadvantages:
  • Still dependent on revenue (though Medicare for All guarantees payment)
  • Less integrated than fully public

Hybrid Approach:

• Large Hospitals: Public ownership (400+ beds)
• Small Rural Hospitals: Could be worker co-ops (community ownership)

3. Implementation: Hospital Transition

Year 1-2: Acquisition

• Government purchases all hospitals: Fair market value
  • HCA shareholders paid $40B (company value)
  • All hospitals are now public assets

Valuation Note:

• Hospital Systems Lobby for High Valuation: "We're worth $100B!"
• Counter: Under Medicare for All, every private hospital becomes worthless (no private insurance = no inflated prices)
  • Pay the current market value, but the value will plummet after M4A passes

Worker Transition:

• All Hospital Workers: Become public employees (or co-op members)
• Wages Increase: (already covered above)
• Benefits Improve: Public employee benefits and pensions
• Job Security: No layoffs (always need healthcare)

4. Insurance Company Elimination

Private Health Insurance Is Banned:

• Cannot Sell Insurance for Medicare-Covered Services: Illegal
• Companies like UnitedHealth, Cigna, Aetna, and Humana: Out of business

500,000 Insurance Workers:

• Jobs Eliminated: Claims processors, underwriters, sales, and executives

Just Transition (See Detailed Section Below)

5. Eliminate Pharmaceutical Benefit Managers (PBMs)

Our Current PBM System:

• Middlemen: Negotiate between insurers, pharmacies, and drug companies
• Three Companies = 80% Market Share: CVS Caremark, Express Scripts, and OptumRx
• Racket: Charge both sides (drug companies pay rebates, pharmacies pay fees), and pocket the difference

Under Medicare for All:

• Government Negotiates Directly: With drug manufacturers
• No Middlemen: PBMs eliminated
• Savings: $50 billion/year

PBM Workers:

• 50,000 Jobs Are Eliminated: with a just transition