If you read or are involved in the strategic planning of a company, invariably you will want more growth. Growth can turn into more profits to then pay shareholders and higher stock valuations, which is good for shareholders. Everyone wins, except possibly the consumer. This is an issue when the largest companies seem and really do have a monopoly, but from their perspective there is always competition in all their fields of operations. At the moment, it is just not affecting profits, but there is competition. An example is the health insurers.

In an article by Reed Abelson and Rebecca Robbins of the New York Times News Service, the 3 biggest health insurers are UnitedHealth Group, CVS Health Group, and Cigna Group.

All the companies are similar to UnitedHealth includes a major insurer; a pharmacy benefit manager; PBM; a vast network of doctors and clinicians; a chain of surgery centers a clearinghouse that processes claims; a mail-order pharmacy and a bank.

Increasingly, Americans rely on one of the 3 titans for nearly all their medical care. The same company that employs their insures them also employs their provider and dispenses their drugs.

The 3 conglomerates each rank among the largest 15 US public companies by sales. None of them were in that category as recent as 2011, according to FactSet, a financial data provider.

Critics say the conglomerates have exploited conflicts to profit from their vast array of businesses, driving up medical costs and dampening competition. For example, a PBM often directs patients to its parent’s company pharmacies. The PBM is responsible compensating drug stores for a patient’s medications, but often it pays other pharmacies less than it does its affiliated pharmacy. What do you think typically happens – go to your pharmacy at higher price or lower price competitor?

The idea that PBMs should be severed from pharmacies has garnered support from 39 state attorney-generals; 25 policy and advocacy groups and Mark Cuban who runs an online pharmacy.

Under President Trump, the idea has been to cut corporate taxes, cut regulations, do you believe President Trump will call for a break up?

Linking to dividend paying stocks, every company wants growth but it you have too much of the pie and the pie is not growing, there will be calls for breakup. If you cast back to the 1900’s there were investment trusts that control almost every industry. Eventually they were all broken up, are we there. no but if consumers are worried about costs, that is one alternative to examine, how much real competition is in the marketplace. President Trump has said in the past, that he was going to fix the health care system in a day or a week with his plan. After 6 years, there still in no plan in sight.

There are more questions than answers, till the next time – to raising questions.