When Luigi Mangione fatally shot UnitedHealthcare CEO Brian Thompson this past December, the internet erupted with declarations of solidarity and anxious calls for condemnation. His vigilante campaign against corporate greed, and subsequent heroization, sparked a wave of moral debate and diagnostic think-pieces. But it didn’t take much analysis to grasp what was driving the sympathetic reaction: deep public anger at the current state of American health care.
On the morning of the shooting, Thompson was headed to an investor conference organized by the insurance company’s parent, UnitedHealth Group, where the agenda was dedicated to the conglomerate’s future growth. Already a behemoth, the multinational corporation controls the largest private health insurer in the country; it also owns the health care provider Optum Health, the pharmacy benefit manager Optum Rx, numerous physician practices, a bank, a consulting firm, and much more. Although the conference was postponed, growth projections likely reflected a continuation of 2024’s trajectory, when the company reportedly acquired or launched more than 250 subsidiaries.
For years, law and political economy scholars have sounded the alarm about America’s “market power problem.” And recently, it has become clear that the health care industry has an advanced case of it. Over the past two decades, there has been unprecedented consolidation across every industry involved in the provision of care—be it private equity groups gobbling up physician practices, the vertical integration of PBMs and pharmacies, or aggressive hospital acquisitions. Indeed, there were at least 428 hospital and health system mergers announced between 2018 and 2023. And while consolidation is often defended on the grounds that it enables economies of scope or scale—potentially lowering costs and improving quality—there are reasons to question whether these efficiencies actually materialize. This is, in part, because consolidation can blunt competition, and on even the most market-friendly outlook, it is competition that drives private firms to lower costs and improve quality in the first place. Empirically, there is growing evidence that concentration and corporatization is increasing the cost of care while quality stagnates (or possibly decreases), and tanking practitioner morale.
As the following pieces in this symposium will demonstrate, at every turn the law has helped fortify and exacerbate health care consolidation and financialization. This has occurred by way of lax antitrust enforcement that has facilitated rampant mergers; convenient contractual workarounds to laws designed to keep practices in the hands of physicians; the adoption of payment frameworks that reward financial engineering and discourage actual care; and regulatory regimes that approve high-priced drugs on thin evidence, obfuscating the true value of care and allowing powerful participants to strengthen their position in the market. As a result, our health has been thoroughly reorganized around the market, squeezed ever-tighter for additional profit.
But just as the law has contributed to market prioritization, it can also serve as a counterforce. As heterodox economist Karl Polanyi observed long ago, when the commodification of our lives grows too severe, society pushes back. The contributors to this series begin to sketch the contours of a progressive pushback—how law, policy, and regulatory action can help erect guardrails to protect us from both illness and insolvency.
