Category: Antitrust

Intel Was a Feared Monopoly but Now “Is in a Fight for Its Life”

(p. B3) It might not look like it yet, but Intel is in a fight for its life.

. . .

The threats to Intel are so numerous that it’s worth summing them up: The Mac and Google’s Chromebooks are already eating the market share of Windows-based, Intel-powered devices. As for Windows-based devices, all signs point to their increasingly being based on non-Intel processors. Finally, Windows is likely to run on the cloud in the future, where it will also run on non-Intel chips.

. . .

It wasn’t always this way. For decades, Intel enjoyed PC market dominance with its ride-or-die partner, Microsoft, through their “Wintel” duopoly.

. . .

I asked Dan Rogers, vice president of silicon performance at Intel, if all of this is keeping him up at night. He declined to comment on Intel’s past, but he did say that since Pat Gelsinger, who had spent the first 30 years of his career at Intel, returned to the company as CEO in 2021, “I believe we are unleashed and focused, and our drive in the PC has in a way never been more intense.”

. . .

Geopolitical factors, for one, have the potential to change the entire chip industry virtually overnight. Intel could suddenly become the only game in town for the most advanced kind of chip manufacturing, if American tech companies lose access to TSMC’s factories on account of China’s aggression toward Taiwan, says Patrick Moorhead, a former executive at Intel competitor AMD, and now head of tech analyst firm Moor Insights & Strategy.

When it comes to Intel, he adds, “Never count these guys out.”

For the full commentary, see:

Christopher Mims. “KEYWORDS; Is This the End of ‘Intel Inside’? Not If Intel Has Anything to Say About It.” The Wall Street Journal (Saturday, Dec. 2, 2023): B13.

(Note: ellipses added.)

(Note: the online version of the commentary has the date December 1, 2023, and has the title “KEYWORDS: CHRISTOPHER MIMS; Is This the End of ‘Intel Inside’?”)

FDA Commissioner Said FDA Was “Too Slow” to Allow Foreign Firms to Supply Baby Formula to Fill Empty Shelves in U.S. Stores

(p. A3) Federal health regulators outlined plans Friday [Sept. 30, 2022] that will allow overseas baby-formula makers to continue selling their products in the U.S. long term following a baby-formula shortage that led to empty shelves at some stores.

. . .

The guidance is expected to help bolster the supply chain for baby formula and could be a financial gain for global manufacturers that have long sought to enter the concentrated U.S. market, where Abbott Laboratories and Reckitt Benckiser Group account for most infant- and toddler-formula sales.

. . .

The FDA responded by temporarily letting foreign manufacturers ship their products to the U.S. FDA Commissioner Robert Califf commissioned an external review of the agency’s food division, saying in congressional testimony that the agency’s response to the shortage was too slow.

For the full story, see:

Stephanie Armour. “FDA Sets New Plan On Baby Formula.” The Wall Street Journal (Saturday, Oct. 1, 2022): A3.

(Note: ellipses, and bracketed date, added.)

(Note: the online version of the story has the date September 30, 2022, and has the title “Overseas Baby-Formula Makers Given Path to Keep Selling in U.S.”)

Perverse Medicare Pricing Incentives Drive Hospital Consolidation Inefficiency

(p. A17) Currently, Medicare pays hospital-owned facilities two to three times as much as independent physician offices for the same service, according to the Alliance for Site Neutral Payment Reform. This creates an enormous incentive for large hospital chains to acquire outpatient practices. Consolidation creates a vicious circle in which larger hospital systems can demand ever higher rates from insurers and also have the capital to buy up physician practices. Removing this perverse incentive will ensure that patients have access to trusted doctors and appropriate care at the same price regardless of treatment location and remove artificial pressure to consolidate.

These bipartisan reforms would deliver hundreds of billions in savings for families. Site-neutral payments would save taxpayers more than $153 billion in Medicare spending over the next decade and also substantially reduce premiums and cost-sharing for Medicare beneficiaries by $94 billion, according to CRFB. In total, these changes could save patients and taxpayers between $346 billion and $672 billion over the next decade.

Large hospital systems have exploited our nation’s outdated billing systems to foist gigantic bills on Americans. Bringing much-needed transparency in hospital billing will deliver more affordable care and put patients back in control.

For the full commentary, see:

Bobby Jindal and Charlie Katebi. “Doctor’s Office Care at Hospital Prices.” The Wall Street Journal (Thursday, July 27, 2023): A17.

(Note: the online version of the commentary has the date July 26, 2023, and has the same title as the print version.)

Federal Trade Commission (FTC) Seeks to Bury Merging Firms in Paperwork

(p. A13) The Federal Trade Commission is trying to make it harder for companies to merge by burying them in paperwork. The FTC’s proposed overhaul of a critical part of the U.S. merger review process would increase the average time to prepare a merger filing from 37 hours to 144. According to the agency’s calculations, that’s roughly $350 million in added costs for an estimated 7,100 filings a year, which would be a boon for lawyers but a burden for businesses.

The one-size-fits-all proposal to add dozens of hours of paperwork per deal—regardless of competitive concerns—is an overreach by the FTC and the Justice Department’s antitrust division that will disproportionately chill investments at the lower end of the reporting threshold.

For the full commentary, see:

Christopher Williams and Henry Hauser. “Antitrust Officials Pile on the Paperwork.” The Wall Street Journal (Wednesday, July 5, 2023): A13.

(Note: the online version of the commentary has the date July 4, 2023, and has the same title as the print version.)

Bell Labs Allowed Tanenbaum to Pursue Any Research that Interested Him

(p. A11) One evening in 1955, Morris Tanenbaum’s wife was playing bridge with friends. Dr. Tanenbaum, a chemist who worked for Bell Telephone Laboratories, the research arm of American Telephone & Telegraph Co., saw a chance to dash back to work to test his latest ideas about how to make better semiconductor devices out of silicon.

He tried a new way of connecting an aluminum wire to a silicon chip. He was thrilled when it worked, providing a way to make highly efficient transistors and other electronic devices, an essential technology for the Information Age.

“I don’t think I needed a car to get home that evening,” he said later in an oral history recorded by the IEEE History Center. “I was flying high.”

Dr. Tanenbaum’s pioneering work in the mid-1950s demonstrated that silicon was a better semiconductor material for transistors than germanium, the early favorite. He earned seven patents.

He later served as a senior executive of AT&T and helped manage the breakup of the phone monopoly mandated by the 1982 settlement of a Justice Department antitrust suit. At the signing of the consent decree, Dr. Tanenbaum cried gently, according to “The Deal of the Century,” a history of the breakup by Steve Coll.

What pained him most was the fate of Bell Laboratories, which had invented the transistor in 1947 and allowed him, as a young Ph.D. chemist in the early 1950s, to pursue basic research even if it didn’t promise near-term financial rewards.  . . .

“Bell Laboratories, the world’s premier industrial laboratory, was destroyed, a major national and global tragedy,” he wrote later in an unpublished memoir written for his family.

. . .

Hired by Bell Laboratories in Murray Hill, N.J. in 1952, he was told to look around for a research project that interested him. Researchers were allowed to pursue nearly any project “potentially related to some Bell System problem or future opportunity,” he wrote later. “What more could a young person expect?”

He zeroed in on studies of potential semiconducting materials. The first transistors were made from germanium, but that material was expensive. Silicon is abundant and thus cheaper. It also helps prevent overheating of circuits. Early efforts to use silicon for electronic devices hadn’t worked well, though. That was a challenge for Dr. Tanenbaum and his colleagues, including Ernie Buehler.

They weren’t alone in finding ways to use silicon. Gordon Teal was doing similar work at Texas Instruments Inc. in the mid-1950s. “From that moment forward, the world was focused on silicon,” Dr. Tanenbaum wrote.

Though AT&T made early breakthroughs, other companies, including Intel Corp. and Texas Instruments, charged ahead with better and faster microchips that transformed the world. AT&T was busy trying to defend its telephone monopoly. On the silicon front, Dr. Tanenbaum said, “we kind of dropped the ball.”

For the full obituary, see:

James R. Hagerty. “Chemist Helped Put Silicon in Microchips.” The Wall Street Journal (Saturday, March 04, 2023): A11.

(Note: ellipses added.)

(Note: the online version of the obituary has the date March 3, 2023, and has the title “Morris Tanenbaum, Who Helped Put Silicon in Microchips, Dies at 94.” The fourth paragraph quoted above appears in the online, but not the print, version.)

The book by Col mentioned above is:

Coll, Steve. The Deal of the Century: The Breakup of AT&T. New York: Atheneum Books, 1986.

The “Affordable” Care Act Gives Huge Drug Subsidies to Rich, Urban “Nonprofit” Hospitals

(p. A1) A decades-old federal program that offered big drug discounts to a small number of hospitals to help low-income patients now benefits some of the most successful nonprofit health systems in the U.S.

Under the program, hospitals buy drugs at reduced prices and sell them to patients and their insurers for much more, often at facilities in affluent communities.

One participant is the Cleveland Clinic’s flagship hospital, which reported $1.35 billion in net income last year. The hospital doesn’t admit enough Medicaid and low-income Medicare patients to qualify for low-cost drugs under the program’s original requirements. But a quirk in federal law allowed the hospital to qualify as a “rural referral center,” despite its location near the center of Cleveland.

Despite the benefits, the program hasn’t resulted in new drug discounts for low-income Cleveland Clinic patients, nor has it caused the hospital to increase the financial assistance it offers to those who can’t afford care. (p. A10) The charity care the main hospital writes off represents less than 2% of its patient revenue, according to a Wall Street Journal analysis of hospital Medicare filings.

. . .

The hospital’s $1.35 billion net income figure for 2021, she said, includes investment returns.

Cleveland Clinic’s adoption of the drug-discount program at its main hospital in April 2020 produced about $136 million in savings on drugs that year, the spokeswoman said.

The federal drug-discount program, known as 340B after the statutory provision that created it, requires pharmaceutical companies to sell drugs to participating hospitals at reduced prices. The program has grown rapidly in recent years. It now includes about 2,600 nonprofit and government hospitals, which spent at least $38 billion on discounted drugs last year, according to the Health Resources and Services Administration, the federal agency known as HRSA that oversees the program.

What the hospitals do with their valuable discounts isn’t always clear.

The program doesn’t require participating hospitals to pass on drug discounts to patients, insurers or Medicare. There is no rule limiting how much they can charge for the drugs. They don’t have to report how much they make from such sales, nor do they have to spend any profits to benefit low-income patients.

. . .

The 2010 Affordable Care Act brought a big expansion of 340B, adding new categories including critical access hospitals, which are small, typically rural facilities, and rural referral centers, which are supposed to be rural hospitals that treat a large volume of patients, including many complicated cases.

Under the federal definition of rural referral centers, hospitals that aren’t in rural locations could still qualify if they meet other criteria—minimally, having at least 275 beds. There is no requirement to serve rural patients.

. . .

“We were trying to help rural hospitals,” said Robert Kocher, an Obama White House health adviser involved in crafting the ACA who is now at venture-capital firm Venrock. “It would not be our intention to have a medical center in Cleveland, Boston or Chicago be included.”

For the full story, see:

Anna Wilde Mathews, Paul Overberg, Joseph Walker and Tom McGinty. “Drug Discounts Aimed at Needy Boost Hospitals.” The Wall Street Journal (Wednesday, Dec. 21, 2022): A1 & A10.

(Note: ellipses added.)

(Note: the online version of the story has the date December 20, 2022, and has the title “Many Hospitals Get Big Drug Discounts. That Doesn’t Mean Markdowns for Patients.”)

Allow Entrepreneurial Competition in Medicine by Ending Obamacare’s Ban on Physician-Owned Hospitals

(p. A17) A tiny paragraph in the enormous Affordable Care Act prohibits physicians from building or owning hospitals. Any existing physician-owned hospital built before 2010 is prohibited from growing beyond the size it was when the bill passed. This law limits competition, defies common sense and is likely contributing to higher prices for Medicare and reduced access to treatment for millions of Americans.

. . .

. . . recent research affirms the power of American entrepreneurship to lower costs and improve quality. Doctors, whether at the bedside or the forefront of scientific innovation, are well-suited to reimagine healthcare operations, lower costs and improve the quality of care.

Specialty physician-owned hospitals focused on cardiology and cardiac surgery were found to deliver higher-quality care than nonprofit hospitals, with lower rates of hospital readmission or mortality for high-risk surgery. Physician-owned specialty hospitals for orthopedic procedures, such as hip and knee replacements, offered lower costs and higher quality than nonprofit counterparts.

. . .

Healthy competition drives job creation, innovation and long-term economic growth. The federal government doesn’t prohibit plumbers from owning plumbing companies, radio hosts from owning radio stations or farmers from owning farmers markets. It’s time to reopen the free market in healthcare and let the power of competition do its work.

For the full commentary, see:

James Lankford and Brian J. Miller. “End ObamaCare’s Ban on Physician-Owned Hospitals.” The Wall Street Journal (Tuesday, Feb. 21, 2023): A17.

(Note: ellipses added.)

(Note: the online version of the commentary has the date February 20, 2023, and has the same title as the print version.)

Feds Gave Bigger Covid Subsidies to Hospitals Charging Higher Prices

(p. A1) When Covid-19 struck, the U.S. government gave hospitals tens of billions of dollars to help them cope with the strains of the pandemic.

Many of the hospitals didn’t need it.

The aid enriched some well-off systems, while failing to meet the needs of many that were struggling, according to a Wall Street Journal analysis of federal financial-disclosure reports.

The mismatch stemmed in part from the way the federal government determined how much a hospital should get. A main factor used to allocate relief was a hospital’s revenue, rather than Covid caseload or financial distress. The idea was that revenue was a good indicator of a hospital’s size.

Among the recipients were large, wealthy hospital owners—including some nonprofits—that reported profits from patient care during the periods they got aid. Some were well off enough to put money into investment funds, while others spent on new facilities and ex-(p. A10)panded campuses.

Hundreds of other hospitals that got federal funding, however, reported losses. Some were forced to lay off nurses and make other cuts, saying they didn’t get enough aid to overcome their strains. Some served areas that had among the highest Covid death rates.

The revenue-based award system, especially prevalent in the early days of the pandemic, tended to favor hospitals with higher prices.

For the full story, see:

Melanie Evans, Liz Essley Whyte and Tom McGinty. “Covid Aid Went to Hospitals That Didn’t Need the Money.” The Wall Street Journal (Monday, Dec. 5, 2022): A1 & A10.

(Note: the online version of the story has the date December 4, 2022, and has the title “Billions in Covid Aid Went to Hospitals That Didn’t Need It.”)

Share of Insulin Revenues Going to Middlemen Pharmacy Benefit Managers (PBMs) Increased by 155%

(p. B12) Pharmacy-benefit managers, or PBMs, have captured a growing slice of America’s world-leading drug spending during the past decade. The spotlight could soon shift to them.

. . .

While the three largest manufacturers of insulin—Eli Lilly, Novo Nordisk and Sanofi—charge more for their products in the U.S. than they do elsewhere, their take of overall spending has been decreasing in recent years as the relative power of middlemen has grown. PBMs have steadily gained negotiating clout by consolidating and merging with large insurance companies. The three largest PBMs are owned by CVS Health Corp. (which owns insurer Aetna), UnitedHealth Group Inc. and Cigna Corp.

. . .

. . . increases in recent years have mostly been passed on to PBMs in the form of heavy discounts that are hidden from public view.

A recent study by University of Southern California scholars showed that, between 2014 and 2018, the share of a hypothetical $100 insulin expenditure accruing to manufacturers decreased by 33%. During that same period, total U.S. spending on insulin hasn’t budged, but the share of insulin expenditures retained by PBMs has increased by 155%.

. . .

“What’s happening in this market is that the middlemen are making more and more money,” said University of Southern California professor Neeraj Sood, one of the authors of the study who has previously done consulting work for drug companies.

Yet the drug-pricing provisions in the recently passed Inflation Reduction Act singularly focused on what manufacturers charge while ignoring other players that take a slice of profits farther down the chain.

For the full commentary, see:

David Wainer. “HEARD ON THE STREET; Sanders, Musk Miss the Mark on Insulin.” The Wall Street Journal (Tuesday, November 22, 2022): B12.

(Note: ellipses added.)

(Note: the online version of the commentary has the date November 21, 2022, and has the title “HEARD ON THE STREET; Elon Musk, Bernie Sanders and Others Miss the Mark Over Pricey Insulin.”)

The academic study co-authored by Sood, and mentioned above, is:

Van Nuys, Karen, Rocio Ribero, Martha Ryan, and Neeraj Sood. “Estimation of the Share of Net Expenditures on Insulin Captured by Us Manufacturers, Wholesalers, Pharmacy Benefit Managers, Pharmacies, and Health Plans from 2014 to 2018.” JAMA Health Forum 2, no. 11 (2021), doi:10.1001/jamahealthforum.2021.3409.

Pharmacy Benefit Managers (PBMs) Create Incentives to Reduce Hiring and Pay of Pharmacists

(p. A1) If any group of workers might have expected their pay to rise last year, it would arguably have been pharmacists. With many drugstores dispensing coronavirus tests and vaccines while filling hundreds of prescriptions each day, working as a pharmacist became a sleep-deprived, lunch-skipping frenzy — one in which ornery customers did not hesitate to vent their frustrations over the inevitable backups and bottlenecks.

“I was stressed all day long about giving immunizations,” said Amanda Poole, who left her job as a pharmacist at a CVS in Tuscaloosa, Ala., in June. “I’d look at patients and say to them, ‘I’d love to fill your prescriptions today, but there’s no way I can.’”

Yet pay for pharmacists, who typically spend six or seven years after high school working toward their professional degree, fell nearly 5 percent last year after adjusting for inflation. Dr. Poole said her pay, about $65 per hour, did not increase in more than four years — first at an independent pharmacy, then at CVS.

For many Americans, one of the pandemic’s few bright spots has been wage growth, with pay rising rapidly for those near the bottom and those at the top. But a broad swath of workers in between has lagged behind.

. . .

(p. A16) Pharmacies also faced external challenges. To hold down the cost of prescription drugs, insurance companies and employers rely on so-called pharmacy benefit managers to negotiate discounts with drugmakers and pharmacies. Consolidation among benefit managers gave them more leverage over pharmacies to drive prices lower. (CVS merged with a large benefits manager in 2007.)

Big drugstore chains often responded by trying to rein in labor costs, according to William Doucette, a professor of pharmacy practice at the University of Iowa. Several pharmacists who worked at Walgreens and CVS said the formulas their companies used to allocate labor resulted in low levels of staffing that were extremely difficult to increase.

According to documents provided by a former CVS pharmacist, managers are motivated by bonuses to stay within these aggressive targets.

. . .

In most cases, an industry without enough workers to meet customer demand would simply hire more, or at least raise wages to attract them.

Yet, according to the Bureau of Labor Statistics, neither of those things happened last year. The number of pharmacists employed in the United States dropped about 1 percent from 2020 to 2021. On balance, employers did not raise wages — in fact, median pay fell slightly, even without adjusting for inflation.

. . .

Several pharmacists said they were especially concerned that understaffing had put patients at risk, given the potentially deadly consequences of mix-ups. “It was so mentally taxing,” said Dr. Poole, the Tuscaloosa pharmacist. “Every day, I was like: I hope I don’t kill anyone.”

. . .

Asked about safety and staffing, CVS and Walgreens said they had made changes, like automating routine tasks, to help pharmacists focus on the most important aspects of their jobs.

Many pharmacists contacted for this article quit rather than face this persistent dread, often taking lower-paying positions.

Still, none had regrets about the decision to leave. “I was 4,000 pounds lighter the moment I sent my resignation email in,” said Dr. Wommack, who left the company in May 2021 and now works at a small community hospital.

As for the medication she had taken for depression and anxiety while at Walgreens, she said, “Shortly after I stopped working there, I stopped taking those pills.”

For the full story, see:

Noam Scheiber. “Why Working At Pharmacies Lost Its Luster.” The New York Times (Tuesday, September 13, 2022): A1 & A16.

(Note: ellipses added.)

(Note: the online version of the story has the same date as the print version, and has the title “How Pharmacy Work Stopped Being So Great.”)

Amazon Warehouse Jobs Give “Economic Boost” to English Town

(p. B4) DARLINGTON, England—Many retailers in this old market town have long held Amazon.com Inc. partially to blame for the closures of a raft of local shops in recent years.

Then, Amazon opened a warehouse here.

The facility, which opened in early 2020, employs 1,300 full-time staff, making it one of the town’s biggest employers. It hired 500 additional seasonal workers during the end-of-year holidays. Wages start at £10 (equivalent to $13.25) an hour, above the legal minimum, and benefits include private healthcare and an £8,000 education allowance available in installments over four years.

The new jobs have all delivered an economic boost for the Northern England town of 100,000, while sparking a reassessment of the U.S. e-commerce giant. Nicola Reading, a gift-shop owner, still blames Amazon for the demise of the local retail scene but now sees an upside, too.

“It feels like Amazon employs half the population of Darlington now,” she said.

Already America’s second-biggest employer, after Walmart Inc., Amazon has been advancing in Europe and the U.K., investing €78 billion ($89 billion) since 2010 in a continentwide expansion that has significantly accelerated over the past few years. Amazon employs over 55,000 full-time U.K. staff.

. . .

Local officials in Darlington have applauded Amazon’s arrival, which they say has benefited the town, chiefly by creating jobs. Amazon’s presence is also encouraging young university graduates to stay in the town and attracting other companies, said Mark Ladyman, the Darlington Borough Council’s assistant director for economic growth.

For the full story, see:

Trefor Moss. “The Small Town That Amazon Upended, Then Saved.” The Wall Street Journal (Saturday, January 22, 2022): B4.

(Note: ellipsis added.)

(Note: the online version of the story was updated Jan. 21, 2022, and has the same title as the print version.)