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The New Behemoths of Health Care Bureaucracy

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What are the ten biggest companies in the United States? Put that question to a group of younger people and they’re likely to rattle off tech giants like Google, Amazon, and Facebook. Older people might mistakenly believe that manufacturing still leads the pack with postwar goliaths such as Ford or General Electric. Oil companies (ExxonMobil, BP) and megabanks (Citi, Wells Fargo) seem obvious contenders.

Yet regardless of who’s doing the guessing, I suspect it would take a very long time before anyone mentioned UnitedHealth, McKesson, and AmerisourceBergen. Who, beyond each firm’s array of boardrooms and back offices, has even heard of them? Nevertheless, they are ranked as 6, 7, and 10, respectively, on this year’s Fortune 500 ranking of the biggest companies by total revenues. If you add CVS-Caremark (#8), four of the ten largest actors in the economy are distinctly low-profile middlemen in the rapacious and wholly inadequate profit-driven system of health care in the U.S., which constitutes an astounding 18 percent of our gross domestic product.

It doesn’t take much digging to figure out where all that money is going. The top 25 entries in the Fortune list also includes Walgreens and Cardinal Health. Mail-order pharmacy service Express Scripts also cracked the top 25 in 2018, but was purchased by Cigna and disappeared in this year’s rankings. That puts effectively seven of the top 25 companies in the nation’s economy in the health care industry—with the vast majority of their revenue derived from administrative activities rather than productive ones, such as manufacturing pharmaceuticals, supplying insurance, or directly providing service to patients. They represent a fast-burgeoning rentier segment of our health care bureaucracy that operates behind the........

© New Republic