which are said to be good if you're healthy but they're only a problem if you get sick so which is crazy united healthcare and humana own 46 of the medicare advantage market explain how two companies controlling half the market can be a detriment to consumers and what it means for the average patient

well so it's it's it's pretty much it's economics 101 and it goes back to um more than a century ago when we started paying attention to monopoly and antitrust in the United States with the passage in 1890 of the Sherman Antitrust Act.

and the belief by the people who did that which was a lot of people in congress and presidents teddy roosevelt robert taft woodrow wilson they they all were supporters of the antitrust because when you allow companies to get too big they will swallow up their competitors or put their competitors out of business so that they can have the maximum possible share of the market and then dictate their prices and so then prices will go up so we know that monopolies lead to higher prices for the affected goods and services and it's important to try to restrain it and control it And that was the belief for about 90 years in the United States with the Sherman Antitrust Act.

But the neoliberals came in in the late 1970s, in particular, a guy some of your listeners have probably heard of and others not.

His name was Robert Bork, B-O-R-K, unsuccessful candidate for the U.S. Supreme Court in the 1980s, notorious hearing process.

But He was part of the University of Chicago Milton Friedman School of Economics.

And he accepted and decided to really make a run with trying to revolutionize antitrust in terms of neoliberal principles so that we would stop just fighting companies getting too big.

So what does the steward story show about private equity in hospitals?

How do you keep it together, John? Is it just committing to the work, making sure that we can come back to it?

It's understanding that things go in waves.

There are ups and there are downs.

And you have to ride through both of them.

And when you're in a good wave like we were over the previous five years where we had a lot of major improvements going on that were spectacular, you can sometimes get complacent.

and sometimes get overconfident.

And then something happens like Trump, too.

Is there a model the United States can and should emulate?

But as Friedman once said, John, free to choose what you think are those.

So I would start I would start with corporate concentration, antitrust, monopoly, oligopoly, all of those terms, because I think in that place, the fingerprints of the impact of the neoliberal group is most recognizable and indisputable.

We started antitrust in the U.S. in 1890 with the Sherman Antitrust Act.

And for about 90 years, we followed the central idea that we needed to discourage corporate concentration and growth toward monopoly as a way to keep society and the economy healthy because when a company gets too big, it stops growing organically and starts growing by buying up or forcing out of business the competition.

And so it's a responsibility only of government that can really lead this to make sure that that doesn't happen.

In the 1950s, the neoliberal movement out of the University of Chicago Economics Department, which had previously said one area of government intervention that they supported was rigorous antitrust policy.

In the 1950s, they did an about-face, and they turned around and they abandoned that line of thinking and And instead started to talk about, well, big isn't necessarily bad as long as if you're big, you provide lower costs to consumers.

probably heard of Robert Bork

But in comparison, all this fragmentation, tell us about how that makes really everybody vulnerable when it's so fragmented like this.

Well, every other system, every other system in advanced nations around the globe, France, Japan, Italy, England, whatever, they all have a system where there's one central source of organization and financing for the system so that there's a level of treatment of people.

Everybody's kind of equal in terms of the health systems around the world.

In the United States, if you're elderly, you go into Medicare.

If you're poor, you go into Medicaid.

If you work for an employer, you go get your employer insurance if your employer offers it to you.

And for different levels of value and care and so forth.

So what was the, you know, what was the sort of marching orders that you guys, how did this, was it a committee that started and you thought let's create something that's statewide first?

But in comparison, all this fragmentation, tell us about how that makes really everybody vulnerable when it's so fragmented like this.

Well, every other system in advanced nations around the globe, you know, France, Japan, Italy, England, whatever, they all have a system where there's one central source of organization and financing for the system so that there's a level of treatment of people.

Everybody's kind of equal in terms of the health systems around the world.

In the United States, if you're elderly, you go into Medicare.

If you're poor, you go into Medicaid.

If you work for an employer, you go get your employer insurance if your employer offers it to you and for different levels of value and care and so forth.

If you can't get any of those, you can try to get coverage through the Affordable Care Act marketplaces.

So what was the, you know, what was the sort of marching orders that you guys, how did this, was it a committee that started and you thought let's create something that's statewide first?

So how did they develop before we get to Reagan?

Yes.

Great question.

Thank you.

So if you wanna understand the true roots of neoliberalism, you have to actually go to the end of World War I and the evaporation of literally Five empires that disintegrated out of that war.

It's just extraordinary.

People don't, I think, appreciate how much so the, the German Empire, the Austro-Hungarian Empire, the Ottoman Empire, the Russian Empire all disappeared.

So can we go through perhaps some of the ways that those ideas about neoliberalism you listed earlier were applied to US healthcare during Reagan's administration and kind of picked up since? Obviously, we're not gonna be able to go into as much detail as the book, but can you give us a sense?

So how do they develop before we get to Reagan?

Yes.

Great question.

Thank you.

So if you wanna understand the true roots of neoliberalism, you have to actually go to the end of World War I and the evaporation of literally five empires that disintegrated out of that war.

It's just extraordinary.

People don't, I think, appreciate how much so.

So can we go through perhaps some of the ways that those ideas about neoliberalism you listed earlier were applied to US healthcare during Reagan's administration and kind of picked up since? Obviously, we're not gonna be able to go into as much detail as the book, but can you give us a sense?

So how did they develop before we get to Reagan?

Yes.

Great question.

Thank you.

So if you want to understand the true roots of neoliberalism, you have to actually go to the end of World War I and the evaporation of literally five empires that disintegrated out of that war.

It's just extraordinary.

People don't, I think, appreciate how much so the German empire the Austro-Hungarian Empire, the Ottoman Empire, the Russian Empire, all disappeared in the wreckage of that.

Can we go through perhaps some of the ways that those ideas about neoliberalism you listed earlier were applied to U.S. healthcare during Reagan's administration and kind of picked up since? Obviously, we're not gonna be able to go into as much detail as the book, but can you give us a sense?

So how did they develop before we get to Reagan?

Yes.

Great question.

Thank you.

So if you want to understand the true roots of neoliberalism, you have to actually go to the end of World War I and the evaporation of literally five empires that disintegrated out of that war.

It's just extraordinary.

People don't, I think, appreciate how much so the, the German Empire, the Austro-Hungarian Empire, the Ottoman Empire, the Russian Empire all disappeared in the wreckage of that.

So can we go through perhaps some of the ways that those ideas about neoliberalism you listed earlier were applied to US healthcare during Reagan's administration and kind of picked up since? Obviously, we're not gonna be able to go into as much detail as the book, but can you give us a sense?