The Middleman Menace: How US Healthcare Giants Siphon Billions from Patient Care

The largest health care companies in America don't provide direct medical services to patients. Instead, they function as middlemen, taking in a significant portion of the country's $5.3 trillion annual healthcare expenditure.

According to recent data, the top ten revenue-generating health care companies in the US are all middlemen, including three insurers that swallowed pharmacy benefit managers and three drug distributors. These companies have grown into global giants, with UnitedHealth ranking fourth on the Fortune Global 500 list and McKesson seventh.

The enormous size of these companies is a distinct feature of the American healthcare system. In contrast, other developed countries such as Germany, Britain, Canada, and Japan have implemented different models that avoid the creation of for-profit middlemen.

The US spends significantly more on healthcare administration than its peers, with an estimated $925 per person spent on overhead in 2021, compared to an average of $245 in other wealthy countries. This represents about 12% of the total difference between what America spends on health and its peers.