In such a rapidly evolving and competitive corporate environment, there is no such thing as permanent monopolies. Even dominant companies face the risk of being weakened or displaced by new competitors.

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For that reason, 1787 generally opposes heavy-handed government intervention, structural breakups, legislation that dictates how private businesses must operate, and arbitrary caps on market share.

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The better way to combat corporate cartel manipulation is to target the misconduct itself: hold executives criminally liable when they knowingly engage in criminal conduct; impose substantial fines; incentivize whistleblowers; encourage private lawsuits; and proactively investigate and screen for corrupt or anticompetitive behavior.

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There is, however, an important exception. 1787 supports breaking apart vertically integrated health-care conglomerates by preventing the same corporate parent from controlling – and profiting from – multiple stages of a patient’s care. Today, a single corporate conglomerate can potentially participate in numerous links of the health-care chain: providing insurance → administering pharmacy benefits (PBM) → operating specialty and mail-order pharmacies → owning physician practices and clinics → providing health-data and other health-services businesses → administering Medicare and Medicaid plans → providing surgical, clinical, and home-health services.

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We do not view this as equivalent to traditional antitrust enforcement aimed at breaking up a company merely because it dominates one market. The objective is not to punish a company for becoming too large or successful, nor to impose an arbitrary ceiling on its market share. It’s to establish structural boundaries between businesses whose competing financial interests can create conflicts when they are controlled by the same corporate parent.

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In other words, an insurer could remain a very large insurer, a pharmacy could remain a very large pharmacy, and a physician group could remain a very large physician group. What would be restricted is common ownership across multiple stages of the same health-care transaction. The distinction is horizontal size versus vertical control.