1 00:00:10,080 --> 00:00:13,360 Speaker 1: Hello, and welcome to another episode of the Ad Thoughts Podcast. 2 00:00:13,480 --> 00:00:16,599 Speaker 1: I'm Tracy Alloway and I'm Joe Whysenthal. Joe, I think 3 00:00:16,600 --> 00:00:19,720 Speaker 1: it's fair to say that anti trust is having a moment. 4 00:00:20,320 --> 00:00:23,320 Speaker 2: It's been having a moment for a while. It feels like, 5 00:00:23,520 --> 00:00:26,639 Speaker 2: especially under this administration, there is this sort of renewed 6 00:00:26,920 --> 00:00:30,080 Speaker 2: energy and interest. Of course, I think last month or 7 00:00:30,080 --> 00:00:34,040 Speaker 2: two months ago we interviewed Jonathan Canter, Jonathan Canter from 8 00:00:34,080 --> 00:00:37,080 Speaker 2: the DOJ, about it, but what our appetite and we 9 00:00:37,080 --> 00:00:37,720 Speaker 2: want to do more. 10 00:00:37,920 --> 00:00:39,760 Speaker 1: That's right, we do want to do more. And a 11 00:00:39,920 --> 00:00:43,000 Speaker 1: lot of this renewed interest in anti trust and even 12 00:00:43,040 --> 00:00:46,440 Speaker 1: controversy is down to Lena Khan, the chair of the 13 00:00:46,479 --> 00:00:50,159 Speaker 1: Federal Trade Commission, the FTC, who's been going after everything 14 00:00:50,200 --> 00:00:54,400 Speaker 1: from big tech to private equity investments in the healthcare industry. 15 00:00:54,680 --> 00:00:57,720 Speaker 1: And I'm very happy to say that today we do, 16 00:00:57,760 --> 00:00:59,520 Speaker 1: in fact have the perfect guest because we're going to 17 00:00:59,560 --> 00:01:02,560 Speaker 1: be speaking to Lena Kahn. I'm very excited, me. 18 00:01:02,560 --> 00:01:05,399 Speaker 2: Too, I'm psyched. I've been looking forward to this episode 19 00:01:05,520 --> 00:01:07,600 Speaker 2: for a long time. I'm thrilled that it's finally here. 20 00:01:07,760 --> 00:01:10,200 Speaker 1: Well, without further ado, uh, Lena, thank you, so much 21 00:01:10,240 --> 00:01:11,160 Speaker 1: for coming on all thoughts. 22 00:01:11,240 --> 00:01:12,280 Speaker 3: Thanks so much for having me. 23 00:01:12,920 --> 00:01:16,080 Speaker 1: So I wanted to sort of dive in immediately into 24 00:01:16,200 --> 00:01:18,560 Speaker 1: some of the most recent stuff you at the FTC 25 00:01:19,000 --> 00:01:23,480 Speaker 1: have been doing. And you recently filed this monopolization claim 26 00:01:23,680 --> 00:01:29,080 Speaker 1: against a PE backed company that's been buying anesthesiology businesses 27 00:01:29,280 --> 00:01:32,399 Speaker 1: in Texas, and I have to say, reading the suit, 28 00:01:33,319 --> 00:01:37,160 Speaker 1: there's some unsettling stuff in there, particularly the bit where 29 00:01:37,360 --> 00:01:39,880 Speaker 1: there's a guy from the company, which is called US 30 00:01:39,920 --> 00:01:43,280 Speaker 1: Anesthesia Partners, where they're buying another business and he's talking 31 00:01:43,319 --> 00:01:45,959 Speaker 1: about how they can now raise their prices, and this 32 00:01:46,080 --> 00:01:49,840 Speaker 1: executive goes chu ching, which you know, I'm guessing you 33 00:01:49,880 --> 00:01:52,640 Speaker 1: don't want to have written down in a lawsuit about 34 00:01:52,760 --> 00:01:54,360 Speaker 1: raising prices and roll up strategies. 35 00:01:54,440 --> 00:01:56,200 Speaker 2: Well, when you when you're filing a suit, you must 36 00:01:56,240 --> 00:01:56,680 Speaker 2: love seeing. 37 00:01:58,080 --> 00:02:01,440 Speaker 1: But okay, here's my question. Why go after roll ups 38 00:02:01,480 --> 00:02:05,600 Speaker 1: in healthcare specifically? And could you theoretically go after private 39 00:02:05,600 --> 00:02:07,200 Speaker 1: equity roll ups anywhere? 40 00:02:07,960 --> 00:02:11,360 Speaker 3: So, just to zoom out, the FTC overseas markets across 41 00:02:11,400 --> 00:02:14,480 Speaker 3: the economy, but that includes healthcare, and healthcare markets are 42 00:02:14,480 --> 00:02:17,360 Speaker 3: some of the most important ones that we oversee precisely 43 00:02:17,400 --> 00:02:20,000 Speaker 3: because this is not a matter of buying toasters or 44 00:02:20,080 --> 00:02:23,679 Speaker 3: vacuum cleaners. Right, this is essential healthcare. And in the 45 00:02:23,800 --> 00:02:27,600 Speaker 3: United States, you know, we pay more for healthcare than 46 00:02:28,040 --> 00:02:31,519 Speaker 3: any other country in the OECD, close to twice as average. 47 00:02:31,560 --> 00:02:35,320 Speaker 3: We pay around a fifth of our GDP, and health 48 00:02:35,440 --> 00:02:38,600 Speaker 3: outcomes are worse off. Right. We see higher rates of 49 00:02:38,760 --> 00:02:42,600 Speaker 3: infant and maternal mortality, We see greater incidents of death 50 00:02:42,720 --> 00:02:46,519 Speaker 3: from avoidable diseases, and so overall we see a whole 51 00:02:46,560 --> 00:02:49,200 Speaker 3: set of problems that are stemming from a whole set 52 00:02:49,240 --> 00:02:52,920 Speaker 3: of factors. The factor that's in our wheelhouse is looking 53 00:02:53,000 --> 00:02:56,080 Speaker 3: at consolidation and a lack of competition, and so we 54 00:02:56,200 --> 00:03:00,680 Speaker 3: enforce the nation's antitrust laws in hospital markets, in pharma markets, 55 00:03:01,200 --> 00:03:03,560 Speaker 3: and we've been wanting to make sure that our enforcement 56 00:03:03,680 --> 00:03:06,920 Speaker 3: efforts are really matching the realities of what we're seeing 57 00:03:06,960 --> 00:03:09,720 Speaker 3: in today's markets. One of the trends that we've seen 58 00:03:09,840 --> 00:03:13,919 Speaker 3: over the last decade is greater expansion of private equity 59 00:03:14,160 --> 00:03:18,040 Speaker 3: in healthcare markets. At the FTC where business model agnostic, 60 00:03:18,200 --> 00:03:20,440 Speaker 3: but we have been hearing from a whole lot of 61 00:03:20,480 --> 00:03:24,720 Speaker 3: market participants, including healthcare workers, about the ways in which 62 00:03:24,760 --> 00:03:29,240 Speaker 3: private equities incursion can result in detrimental outcomes. There was 63 00:03:29,280 --> 00:03:32,200 Speaker 3: a study that found that, for example, when private equity 64 00:03:32,200 --> 00:03:36,360 Speaker 3: bought out nursing homes, that you saw higher mortality rates. Right, 65 00:03:36,400 --> 00:03:38,600 Speaker 3: So this is not even just about pricing, but it 66 00:03:38,600 --> 00:03:41,560 Speaker 3: can really be life or death. So that's really overall 67 00:03:41,640 --> 00:03:44,320 Speaker 3: what has stemmed our interest in taking a closer look 68 00:03:44,320 --> 00:03:47,280 Speaker 3: at private equity and what ultimately led to the suit 69 00:03:47,360 --> 00:03:48,520 Speaker 3: and the investigation. 70 00:03:48,920 --> 00:03:51,320 Speaker 1: But what about in other industries? Is that something that 71 00:03:51,360 --> 00:03:53,000 Speaker 1: you could theoretically also look at. 72 00:03:53,400 --> 00:03:57,160 Speaker 3: Yeah, so we can look at businesses across the US 73 00:03:57,240 --> 00:04:00,960 Speaker 3: economy and how they're structured and what they're particular business 74 00:04:00,960 --> 00:04:05,400 Speaker 3: model is can vary. We've been particularly focused on healthcare markets, 75 00:04:05,440 --> 00:04:08,920 Speaker 3: but especially after we filed this lawsuit, we've been hearing 76 00:04:08,960 --> 00:04:12,880 Speaker 3: from market participants across sectors about additional areas where they 77 00:04:13,080 --> 00:04:15,880 Speaker 3: believe that, you know, we should be scrutinizing, be it 78 00:04:15,920 --> 00:04:17,160 Speaker 3: in healthcare or elsewhere. 79 00:04:17,920 --> 00:04:21,720 Speaker 2: So it's not against the law to raise prices generally, 80 00:04:21,960 --> 00:04:25,400 Speaker 2: and it might be elevised and it might make lawyers cringe, 81 00:04:25,440 --> 00:04:27,680 Speaker 2: but it's also not against the law to right chi 82 00:04:27,800 --> 00:04:30,640 Speaker 2: ching and an email. You know, the game is to 83 00:04:30,680 --> 00:04:34,520 Speaker 2: make money. What is it about this case that makes 84 00:04:34,560 --> 00:04:40,360 Speaker 2: it to your mind, anti competitive beyond just profitable raising money. 85 00:04:40,600 --> 00:04:43,560 Speaker 3: Yeah, it's a good question. So this case is about 86 00:04:43,640 --> 00:04:47,279 Speaker 3: a roll up scheme that was architected by the private 87 00:04:47,279 --> 00:04:51,440 Speaker 3: equity firm Walsh Carson, and our lawsuit both names USAP 88 00:04:51,880 --> 00:04:54,760 Speaker 3: as well as Walsh Carson because they were ultimately the 89 00:04:55,120 --> 00:04:59,320 Speaker 3: core mastermind. And what happened was Welsh Carson recognized that 90 00:04:59,480 --> 00:05:04,040 Speaker 3: the theesiology markets in Texas were quite fragmented and that 91 00:05:04,680 --> 00:05:07,560 Speaker 3: created an opportunity for them to go in do a 92 00:05:07,600 --> 00:05:10,279 Speaker 3: whole set of acquisitions. They ended up buying out some 93 00:05:10,400 --> 00:05:14,680 Speaker 3: of the largest anesthesiology practices in Texas in ways that 94 00:05:14,839 --> 00:05:18,080 Speaker 3: eliminated competition. Right, So you had a market that previously 95 00:05:18,200 --> 00:05:23,040 Speaker 3: was fragmented where different anesthesiology providers were competing against one another, 96 00:05:23,440 --> 00:05:25,840 Speaker 3: but ultimately, when they were a whole bunch of them 97 00:05:25,880 --> 00:05:29,440 Speaker 3: put under the same ownership, that competition was eliminated. And 98 00:05:29,520 --> 00:05:32,640 Speaker 3: we saw the effects of that pretty clearly because these 99 00:05:32,800 --> 00:05:36,240 Speaker 3: entities were able to ultimately jack up prices, and so 100 00:05:36,320 --> 00:05:38,839 Speaker 3: they did that in a whole set of cities across 101 00:05:38,920 --> 00:05:43,760 Speaker 3: Texas for the anesthesiology practices that they weren't able to 102 00:05:43,800 --> 00:05:47,560 Speaker 3: buy outright, they ended up entering into all sorts of 103 00:05:47,640 --> 00:05:51,480 Speaker 3: agreements either not to enter each other's markets or to 104 00:05:51,720 --> 00:05:55,800 Speaker 3: coordinate and ultimately hike prices. Nevertheless, so there's a whole 105 00:05:55,880 --> 00:05:59,400 Speaker 3: set of anti competitive conduct that we alleged was going 106 00:05:59,400 --> 00:06:02,280 Speaker 3: on here, and that's reflected and the whole set of 107 00:06:02,320 --> 00:06:06,680 Speaker 3: antitrust claims that we bring both illegal acquisitions but monopolization 108 00:06:06,960 --> 00:06:09,640 Speaker 3: as well as illegal market allocation schemes. 109 00:06:10,760 --> 00:06:12,680 Speaker 1: One of the things I'm interested in, and we spoke 110 00:06:12,720 --> 00:06:15,520 Speaker 1: a little bit to Jonathan Kanter about this, but how 111 00:06:15,520 --> 00:06:19,000 Speaker 1: do you actually go about examining an industry and how 112 00:06:19,000 --> 00:06:23,120 Speaker 1: did these things actually land on your radar? Because when 113 00:06:23,120 --> 00:06:25,680 Speaker 1: we're doing odd thoughts, one of the things I think 114 00:06:25,680 --> 00:06:28,960 Speaker 1: we've learned over the years is that even after we 115 00:06:29,040 --> 00:06:31,599 Speaker 1: dive into a particular business for an hour, we often 116 00:06:31,640 --> 00:06:34,080 Speaker 1: come away with more questions and this leads to, you know, 117 00:06:34,120 --> 00:06:37,400 Speaker 1: five more hour long episodes about a single business. So 118 00:06:38,120 --> 00:06:41,400 Speaker 1: what is your research process actually like? And then also, 119 00:06:41,960 --> 00:06:43,719 Speaker 1: I know you said you were going to be reaching 120 00:06:43,760 --> 00:06:46,720 Speaker 1: out to doctors to try to get more stories about 121 00:06:46,720 --> 00:06:49,719 Speaker 1: the impact of PE on the healthcare industry, But what 122 00:06:49,760 --> 00:06:51,200 Speaker 1: are the types of things that you're hearing? 123 00:06:52,320 --> 00:06:56,239 Speaker 3: So we have phenomenal staff at the FTC who are deep, 124 00:06:56,279 --> 00:06:58,680 Speaker 3: deep experts. I mean, these are the people who are 125 00:06:58,720 --> 00:07:02,719 Speaker 3: really drilling in to the intricate mechanics of how various 126 00:07:02,720 --> 00:07:06,560 Speaker 3: markets work. What are the contracting practices like if you're 127 00:07:06,600 --> 00:07:09,080 Speaker 3: looking at pharma, you know, drilling down into what is 128 00:07:09,120 --> 00:07:12,520 Speaker 3: the active ingredient, what are like the drugs and the pipeline. 129 00:07:12,560 --> 00:07:16,680 Speaker 3: I mean, really just incredible mastery over just the nuts 130 00:07:16,680 --> 00:07:19,200 Speaker 3: and bolts of all sorts of markets across the US, 131 00:07:19,600 --> 00:07:23,920 Speaker 3: and so we really rely on their expertise. Beyond that, 132 00:07:24,080 --> 00:07:27,600 Speaker 3: you know, we solicit information from a range of sources. 133 00:07:27,760 --> 00:07:30,480 Speaker 3: One thing that I've been really focused on is making 134 00:07:30,520 --> 00:07:33,960 Speaker 3: sure we're regularly engaging the broader public, and so we 135 00:07:34,080 --> 00:07:37,040 Speaker 3: do these regular commission meetings where anybody can sign up 136 00:07:37,080 --> 00:07:39,880 Speaker 3: and come talk to us. We've opened up a whole 137 00:07:39,920 --> 00:07:43,960 Speaker 3: set of public dockets asking for information about certain types 138 00:07:44,000 --> 00:07:48,000 Speaker 3: of contracting practices. We're doing an inquiry right now into 139 00:07:48,040 --> 00:07:51,320 Speaker 3: pharmacy benefit managers the PBMs, which are these middlemen and 140 00:07:51,360 --> 00:07:54,360 Speaker 3: the pharmaceutical supply chain. We've been getting a whole set 141 00:07:54,360 --> 00:07:58,360 Speaker 3: of comments from independent pharmacies to patient advocates, and so 142 00:07:58,520 --> 00:08:01,640 Speaker 3: we really want to make sure that you're sourcing broadly 143 00:08:01,760 --> 00:08:06,120 Speaker 3: and making sure those information gathering channels are open, and 144 00:08:06,160 --> 00:08:08,840 Speaker 3: really to make sure that our understanding of markets is 145 00:08:08,880 --> 00:08:12,400 Speaker 3: really reflecting the reality. And this is actually how I 146 00:08:12,440 --> 00:08:15,360 Speaker 3: got my start in anti trust as a business journalist 147 00:08:15,360 --> 00:08:17,840 Speaker 3: and researcher, and one of my jobs was to really 148 00:08:18,120 --> 00:08:22,120 Speaker 3: drill down and understand how various markets were faring, especially 149 00:08:22,160 --> 00:08:25,800 Speaker 3: after decades of consolidation. And it was really that work 150 00:08:26,080 --> 00:08:30,000 Speaker 3: and talking to market participants and understanding the reality and 151 00:08:30,080 --> 00:08:33,240 Speaker 3: mechanics of their day to day and actually seeing how 152 00:08:33,280 --> 00:08:36,400 Speaker 3: that departed from what some of the models in theories 153 00:08:36,440 --> 00:08:39,480 Speaker 3: and anti trust were predicting. That really gave me a 154 00:08:39,520 --> 00:08:42,840 Speaker 3: renewed appreciation for actually talking to the people in these 155 00:08:42,840 --> 00:08:45,679 Speaker 3: markets to understand what's going on rather than just relying 156 00:08:45,679 --> 00:08:46,840 Speaker 3: on our models and theories. 157 00:08:47,400 --> 00:08:50,440 Speaker 2: One thing I really like about when reading through the 158 00:08:50,480 --> 00:08:54,920 Speaker 2: complaint against US Anesthesia Partners, there's a really long conversation 159 00:08:55,040 --> 00:08:58,080 Speaker 2: in there, just essentially about how the business model of 160 00:08:58,240 --> 00:09:01,040 Speaker 2: anesthesia works and the relationship that the clinics have with 161 00:09:01,080 --> 00:09:04,600 Speaker 2: the hospitals and how those arrangements are set. You know 162 00:09:04,800 --> 00:09:08,040 Speaker 2: something though I'm curious about reading this is no one 163 00:09:08,120 --> 00:09:10,959 Speaker 2: knows what the outcome is it seems straightforward. It seems 164 00:09:11,000 --> 00:09:14,319 Speaker 2: like what we all think of as sort of classical 165 00:09:14,440 --> 00:09:18,040 Speaker 2: anti competitive behavior. And the way you describe it is, yeah, 166 00:09:18,360 --> 00:09:21,959 Speaker 2: they bought a bunch of regional clinics, got a big 167 00:09:22,040 --> 00:09:24,000 Speaker 2: chunk of the market and raised prices, which I think 168 00:09:24,040 --> 00:09:26,840 Speaker 2: if you ask people what anti competitive behavior looks like, 169 00:09:27,120 --> 00:09:30,360 Speaker 2: it's something like that garnering a big and then saying 170 00:09:30,400 --> 00:09:32,440 Speaker 2: chi ching and then saying chi ching. But the reason 171 00:09:32,600 --> 00:09:34,959 Speaker 2: why I ask is that, you know, obviously, I think 172 00:09:35,000 --> 00:09:38,000 Speaker 2: a lot of people associate your work with a sort 173 00:09:38,000 --> 00:09:42,520 Speaker 2: of broader theory of anti trust related to corporate power 174 00:09:42,679 --> 00:09:46,640 Speaker 2: and other ways that powerful corporate entities can affect employees 175 00:09:46,840 --> 00:09:50,559 Speaker 2: or consumer or smaller businesses. Is it fair to say, though, 176 00:09:50,600 --> 00:09:53,560 Speaker 2: that this is sort of retro old school anti trust 177 00:09:53,720 --> 00:09:57,160 Speaker 2: is sort of a retro example of anti trust enforcement. 178 00:09:57,400 --> 00:09:59,880 Speaker 3: I mean, everything we do is old school anti trust. 179 00:10:01,320 --> 00:10:01,680 Speaker 1: Knowledge. 180 00:10:02,200 --> 00:10:04,319 Speaker 2: There's some new thing, but it just feels it does 181 00:10:04,360 --> 00:10:08,720 Speaker 2: not feel like some exotic or some sort of trendy 182 00:10:08,840 --> 00:10:10,120 Speaker 2: legal theory. Yeah. 183 00:10:10,160 --> 00:10:12,280 Speaker 3: So, look, the interesting thing about anti trust is that 184 00:10:12,320 --> 00:10:15,720 Speaker 3: our foundational statutes are over one hundred years old, right. 185 00:10:15,760 --> 00:10:18,520 Speaker 3: The Sherman Anti Trust Act was pass in eighteen ninety 186 00:10:18,640 --> 00:10:21,080 Speaker 3: You then had the Clayton Act the FTC Act, which 187 00:10:21,120 --> 00:10:24,880 Speaker 3: created the Federal Trade Commission in nineteen fourteen. And these 188 00:10:24,960 --> 00:10:29,600 Speaker 3: laws set out terms like unfair methods of competition or 189 00:10:29,679 --> 00:10:33,600 Speaker 3: restraints of trade, and at various points lawmakers had debates 190 00:10:33,640 --> 00:10:36,720 Speaker 3: they said, should we define more specifically what that means? 191 00:10:37,160 --> 00:10:40,200 Speaker 3: And they decided against it because they realized that as 192 00:10:40,320 --> 00:10:44,640 Speaker 3: markets change, as technologies change, as business models change, firms 193 00:10:44,679 --> 00:10:48,040 Speaker 3: are going to be endlessly innovative in how they monopolize 194 00:10:48,120 --> 00:10:50,720 Speaker 3: right the tactics that they use. And so they left 195 00:10:50,720 --> 00:10:54,320 Speaker 3: it open ended for enforcers to use their expertise to 196 00:10:54,440 --> 00:10:59,040 Speaker 3: do deep investigations and make sure that those principles were 197 00:10:59,040 --> 00:11:02,959 Speaker 3: being vindicated no matter whether you're in a smokestack industry 198 00:11:03,280 --> 00:11:05,400 Speaker 3: or in the context of private equity, or in the 199 00:11:05,440 --> 00:11:08,240 Speaker 3: context of some of these newer digital markets. And so 200 00:11:08,360 --> 00:11:11,440 Speaker 3: those are really the principles that were animated by and 201 00:11:11,480 --> 00:11:13,680 Speaker 3: that we look to vindicate throughout our work. 202 00:11:14,040 --> 00:11:17,480 Speaker 2: Well, let me just ask as a follow up, I mean, presumably, 203 00:11:17,480 --> 00:11:19,720 Speaker 2: as you said, you're collecting more comments, you're looking at 204 00:11:19,760 --> 00:11:24,719 Speaker 2: more areas, et cetera. Is there anything in this particular 205 00:11:24,920 --> 00:11:28,920 Speaker 2: case that was anti competitive but not in this sort 206 00:11:28,920 --> 00:11:33,360 Speaker 2: of straightforward garnering market share and raising prices. In other words, 207 00:11:33,640 --> 00:11:36,920 Speaker 2: are there other types of roll ups, perhaps in healthcare, 208 00:11:37,280 --> 00:11:40,400 Speaker 2: perhaps other parts of other things that private equity might 209 00:11:40,440 --> 00:11:43,360 Speaker 2: engage in where this case could serve as a warning, 210 00:11:43,600 --> 00:11:47,080 Speaker 2: even if the strategy isn't about, oh, let's get seventy 211 00:11:47,080 --> 00:11:48,640 Speaker 2: percent of the market and raise prices. 212 00:11:49,280 --> 00:11:52,240 Speaker 3: So this is the first roll up case that the 213 00:11:52,280 --> 00:11:55,600 Speaker 3: FTC has brought in several decades. And what I mean 214 00:11:55,640 --> 00:11:59,440 Speaker 3: by that is that this case was about not just 215 00:11:59,559 --> 00:12:03,360 Speaker 3: looking at each acquisition in a silo, but really looking 216 00:12:03,440 --> 00:12:06,240 Speaker 3: at them in the aggregate, right, And that's really what 217 00:12:06,320 --> 00:12:08,640 Speaker 3: we see with some of these roll up and serial 218 00:12:08,679 --> 00:12:12,160 Speaker 3: acquisition strategies is that they may be composed of a 219 00:12:12,200 --> 00:12:16,560 Speaker 3: whole set of individual transactions and acquisitions. Each one, when 220 00:12:16,600 --> 00:12:19,640 Speaker 3: considered in a silo, may not seem problematic from a 221 00:12:19,640 --> 00:12:22,320 Speaker 3: competition perspective. Right. Some of them may not even be 222 00:12:22,440 --> 00:12:24,719 Speaker 3: reportable because they may be, you know, just a few 223 00:12:24,760 --> 00:12:27,440 Speaker 3: tens of millions of dollars and not even trigger the 224 00:12:27,480 --> 00:12:30,640 Speaker 3: heart's got Redino filing. And so you may have a series, 225 00:12:30,880 --> 00:12:33,800 Speaker 3: each one of which is small and may seem benign. 226 00:12:34,200 --> 00:12:36,840 Speaker 3: But when you zoom out and look in the aggregate. 227 00:12:37,120 --> 00:12:38,960 Speaker 3: You have what you may have seen is a rollup 228 00:12:38,960 --> 00:12:42,280 Speaker 3: of a market. And so this case should really put 229 00:12:42,520 --> 00:12:45,680 Speaker 3: market participants on notice that the FTC is going to 230 00:12:45,679 --> 00:12:49,000 Speaker 3: be looking at these deals in the aggregate. We're reserving 231 00:12:49,040 --> 00:12:52,120 Speaker 3: that right for ourselves rather than just looking at each 232 00:12:52,200 --> 00:12:53,679 Speaker 3: one in a silo. 233 00:12:53,960 --> 00:12:56,520 Speaker 1: Well, on that note, when I think of roll up strategies, 234 00:12:56,559 --> 00:12:59,200 Speaker 1: I think of them as kind of a foundational aspect 235 00:12:59,280 --> 00:13:01,560 Speaker 1: of private XA. And I think it's fair to say 236 00:13:01,559 --> 00:13:03,800 Speaker 1: that there are a lot of you know, pe decks 237 00:13:03,840 --> 00:13:07,560 Speaker 1: that go around where they talk about multiple acquisitions and 238 00:13:07,640 --> 00:13:11,040 Speaker 1: the ability that gives them in pricing power. So I 239 00:13:11,040 --> 00:13:14,120 Speaker 1: guess it's unsurprising that you have seen some pushback and 240 00:13:14,160 --> 00:13:17,800 Speaker 1: some lobbying recently. I think Politico just this week or 241 00:13:17,880 --> 00:13:20,600 Speaker 1: last week ran a story calling you Wall Street's enemy 242 00:13:21,240 --> 00:13:24,439 Speaker 1: number one, something to that effect. And we have seen 243 00:13:24,520 --> 00:13:31,839 Speaker 1: businesses trying to use political partisanship to persuade some politicians 244 00:13:31,880 --> 00:13:34,920 Speaker 1: to maybe repeal some of these laws or kind of 245 00:13:34,920 --> 00:13:39,000 Speaker 1: push back against them. How does that impact what you do? 246 00:13:39,240 --> 00:13:43,400 Speaker 1: And I guess how vulnerable are some of the directional 247 00:13:43,440 --> 00:13:46,480 Speaker 1: shifts or changes that you've made at the FTC to 248 00:13:46,679 --> 00:13:48,320 Speaker 1: this type of political pressure. 249 00:13:49,440 --> 00:13:52,840 Speaker 3: Look embedded in the DNA of the FTC is when 250 00:13:53,000 --> 00:13:55,880 Speaker 3: as an agency, we're being faithful to the statutes, right, 251 00:13:55,920 --> 00:13:58,959 Speaker 3: the anti monopoly statutes, we're going to be pitted up 252 00:13:59,000 --> 00:14:03,200 Speaker 3: against monopoly and very well healed interests, right. And these 253 00:14:03,480 --> 00:14:06,480 Speaker 3: entities have power, they have resources, and they have a 254 00:14:06,480 --> 00:14:09,640 Speaker 3: lot to lose if the antitrust laws are faithfully enforced, 255 00:14:10,040 --> 00:14:12,920 Speaker 3: and so you know, that type of pushback is probably 256 00:14:12,960 --> 00:14:15,600 Speaker 3: baked in if we're doing our job and being effective. 257 00:14:16,000 --> 00:14:18,920 Speaker 3: The important thing, though, to recall, is that the business 258 00:14:18,920 --> 00:14:21,840 Speaker 3: community is not a monolith, right, And we've been hearing 259 00:14:22,120 --> 00:14:28,360 Speaker 3: equally from businesses, from entrepreneurs, from startups about the ways 260 00:14:28,400 --> 00:14:33,480 Speaker 3: in which consolidation and anti competitive practices are locking them 261 00:14:33,480 --> 00:14:36,800 Speaker 3: out of markets, are muscling them or squeezing them. We 262 00:14:36,920 --> 00:14:40,320 Speaker 3: heard a lot from independent pharmacies, for example, about the 263 00:14:40,360 --> 00:14:44,120 Speaker 3: ways in which vertical integration by PBMs may be leading 264 00:14:44,160 --> 00:14:48,520 Speaker 3: to practices that is, you know, squeezing them. And especially 265 00:14:48,520 --> 00:14:51,119 Speaker 3: in rural areas where you have some of these independent 266 00:14:51,400 --> 00:14:55,320 Speaker 3: pharmacies shutter. That's essential healthcare that's no longer being provided 267 00:14:55,360 --> 00:14:59,000 Speaker 3: to communities. The other week, I spoke to a conference 268 00:14:59,160 --> 00:15:03,080 Speaker 3: of ERD doctors who shared the way in which private 269 00:15:03,120 --> 00:15:08,000 Speaker 3: equity expansion into emergency medicine they believe is really harming 270 00:15:08,080 --> 00:15:11,480 Speaker 3: not just the doctors, but ultimately the quality of patient care. 271 00:15:11,920 --> 00:15:15,440 Speaker 3: And so these are real problems with real material effects 272 00:15:15,480 --> 00:15:17,960 Speaker 3: on people. And so that's where making sure that we're 273 00:15:18,160 --> 00:15:21,520 Speaker 3: hearing broadly and not just from you know, well healed 274 00:15:21,520 --> 00:15:24,960 Speaker 3: companies that can afford lobbyists in DC is really critical, 275 00:15:25,000 --> 00:15:26,840 Speaker 3: and make sure that we're keeping our eye on the 276 00:15:26,880 --> 00:15:40,720 Speaker 3: prize and faithfully doing our jobs. 277 00:15:45,240 --> 00:15:48,680 Speaker 2: I'm glad you brought up the potential harm to doctors 278 00:15:48,680 --> 00:15:50,760 Speaker 2: and obviously the quality of care. There was an interesting 279 00:15:50,840 --> 00:15:53,200 Speaker 2: article I read. I guess it was just yesterday in 280 00:15:53,240 --> 00:15:57,200 Speaker 2: the American Prospect about the AMA considering a resolution for 281 00:15:57,440 --> 00:16:00,600 Speaker 2: a federal ban on the corporate practice of medicine, and 282 00:16:00,680 --> 00:16:02,400 Speaker 2: I guess, you know, I want to go back to 283 00:16:02,440 --> 00:16:04,000 Speaker 2: what you said about I think was in the first 284 00:16:04,080 --> 00:16:07,440 Speaker 2: question about listening to more people and opening up comments. 285 00:16:07,840 --> 00:16:10,080 Speaker 2: Are you hearing the same thing the sort of frustration 286 00:16:10,160 --> 00:16:14,120 Speaker 2: from doctors, And could the FTC in theory take action 287 00:16:14,200 --> 00:16:16,560 Speaker 2: at some point in the future against an entity that 288 00:16:16,720 --> 00:16:21,200 Speaker 2: wasn't necessarily aggressively raising prices but by dint of their 289 00:16:21,280 --> 00:16:26,080 Speaker 2: having rolled up multiple clinics are mistreating workers or mistreating patients, 290 00:16:26,080 --> 00:16:27,040 Speaker 2: like could that be enough? 291 00:16:28,040 --> 00:16:31,960 Speaker 3: So the antitrust laws protect everybody. They protect patients and consumers, 292 00:16:32,000 --> 00:16:35,640 Speaker 3: but they're also supposed to protect workers. And we've seen 293 00:16:35,680 --> 00:16:39,640 Speaker 3: over the last decade, in particular, significant empirical research from 294 00:16:40,080 --> 00:16:43,240 Speaker 3: labor economists finding that labor markets in the US are 295 00:16:43,320 --> 00:16:46,920 Speaker 3: much more concentrated on average than previously believed, and that 296 00:16:46,960 --> 00:16:50,360 Speaker 3: you have what's called, you know, monopsony power that can 297 00:16:50,400 --> 00:16:54,040 Speaker 3: give employers outsized power over their workers when they're not 298 00:16:54,200 --> 00:16:58,400 Speaker 3: checked adequately by competition. So that's a dimension of competition 299 00:16:58,800 --> 00:17:01,920 Speaker 3: labor markets that we are very much looking at. The 300 00:17:02,040 --> 00:17:04,840 Speaker 3: revised merger guidelines that we put out a draft of 301 00:17:04,880 --> 00:17:08,880 Speaker 3: this past summer includes a particular guideline laying out how 302 00:17:08,920 --> 00:17:12,879 Speaker 3: we will assess whether mergers may unlawfully lessen competition in 303 00:17:13,000 --> 00:17:16,199 Speaker 3: labor markets. And one of the hospital mergers that we 304 00:17:16,280 --> 00:17:20,640 Speaker 3: sued to block last year in Rhode Island included analysis 305 00:17:20,680 --> 00:17:22,960 Speaker 3: about how the merger would be bad not just for 306 00:17:23,040 --> 00:17:27,200 Speaker 3: patients but also for registered nurses. So it's becoming more 307 00:17:27,240 --> 00:17:30,680 Speaker 3: and more key part of our analysis. Earlier this year 308 00:17:30,680 --> 00:17:34,480 Speaker 3: In January, the FTC also brought a series of enforcement 309 00:17:34,560 --> 00:17:38,080 Speaker 3: actions relating to the use of non compete clauses. So 310 00:17:38,119 --> 00:17:42,000 Speaker 3: we brought one lawsuit against this company called Prudential Security. 311 00:17:42,200 --> 00:17:45,199 Speaker 3: It's been employing security guards that were making close to 312 00:17:45,280 --> 00:17:48,480 Speaker 3: minimum wage, and it had imposed on them these non 313 00:17:48,520 --> 00:17:52,119 Speaker 3: compete clauses that we alleged were coercive and unfair methods 314 00:17:52,160 --> 00:17:55,600 Speaker 3: of competition. We also brought a set of cases in 315 00:17:55,640 --> 00:17:59,359 Speaker 3: the glass manufacturing industry. This is a part of the 316 00:17:59,359 --> 00:18:02,840 Speaker 3: market that's quite concentrated. You basically have three big players, 317 00:18:03,240 --> 00:18:05,880 Speaker 3: and we allege that their use of non competes had 318 00:18:05,880 --> 00:18:08,440 Speaker 3: not even just been bad for workers, but it actually 319 00:18:08,520 --> 00:18:12,200 Speaker 3: harmed competition because if you had an upstart who wanted 320 00:18:12,240 --> 00:18:14,159 Speaker 3: to enter the market, they believed that was, you know, 321 00:18:14,240 --> 00:18:16,679 Speaker 3: excess demand that they could come in and fill, they 322 00:18:16,720 --> 00:18:19,720 Speaker 3: wouldn't be able to scale ultimately because the relevant talent 323 00:18:19,760 --> 00:18:21,919 Speaker 3: pool was all locked up through these non competes. So 324 00:18:22,640 --> 00:18:25,560 Speaker 3: that's becoming a greater part of our work. In January, 325 00:18:25,640 --> 00:18:29,439 Speaker 3: we also proposed a rule that would eliminate non compete 326 00:18:29,440 --> 00:18:33,760 Speaker 3: clauses in employment contracts for the vast majority of workers, 327 00:18:33,800 --> 00:18:37,360 Speaker 3: with a couple of exceptions. And that again was stemming 328 00:18:37,400 --> 00:18:40,120 Speaker 3: from a whole set of empirical research that found that 329 00:18:40,240 --> 00:18:43,879 Speaker 3: non competes maybe depressing workers' wages to the tune of 330 00:18:43,920 --> 00:18:47,280 Speaker 3: three hundred billion dollars a year annually. One thing that 331 00:18:47,320 --> 00:18:49,520 Speaker 3: was very interesting to me was that, you know, you 332 00:18:49,520 --> 00:18:51,840 Speaker 3: can imagine how the non compete may be bad for 333 00:18:51,920 --> 00:18:55,720 Speaker 3: the worker that's directly covered by the non compete, but interestingly, 334 00:18:55,920 --> 00:18:58,920 Speaker 3: they also have a negative effect even on workers who 335 00:18:58,960 --> 00:19:01,600 Speaker 3: are not directly covered, which kind of makes sense, right, 336 00:19:01,640 --> 00:19:05,360 Speaker 3: if there's less churn in the economy because workers are 337 00:19:05,600 --> 00:19:08,040 Speaker 3: locked in by a non compete, that means there are 338 00:19:08,119 --> 00:19:11,360 Speaker 3: fewer opportunities even for workers that are not covered by 339 00:19:11,400 --> 00:19:14,160 Speaker 3: non compete. So we found harm to workers, we also 340 00:19:14,240 --> 00:19:17,760 Speaker 3: found harm to competition and to innovation, and so this 341 00:19:17,840 --> 00:19:20,600 Speaker 3: is another area of our work where we're looking at 342 00:19:20,640 --> 00:19:23,440 Speaker 3: product markets, but we're also looking at labor markets. 343 00:19:23,480 --> 00:19:26,040 Speaker 2: Tracy, that's interesting about the non competes. It's almost like 344 00:19:26,160 --> 00:19:29,560 Speaker 2: the corollarya or flip side to what we've talked about recently, 345 00:19:29,640 --> 00:19:32,439 Speaker 2: workers getting wages even if they're not in the union 346 00:19:32,880 --> 00:19:35,720 Speaker 2: from wage gains. So what may affect just sort of 347 00:19:35,760 --> 00:19:39,199 Speaker 2: one subset of workers has broader impact on it. 348 00:19:39,280 --> 00:19:41,760 Speaker 1: Oh totally. Also, can I just say, ever since the 349 00:19:41,880 --> 00:19:45,439 Speaker 1: twenty eighteen Jackson hole, I get really excited whenever anyone 350 00:19:45,440 --> 00:19:47,920 Speaker 1: says monopsony, thanks. 351 00:19:48,000 --> 00:19:51,439 Speaker 2: We need an air hornyye off, what Tracy? 352 00:19:51,600 --> 00:19:55,040 Speaker 1: But I mean, just on this labor issue point, I mean, 353 00:19:55,080 --> 00:19:57,040 Speaker 1: this is where we're sort of getting into the heart 354 00:19:57,240 --> 00:20:00,320 Speaker 1: of the idea of hipster antitrust or sort of moving 355 00:20:00,359 --> 00:20:04,520 Speaker 1: away from more traditional or classical interpretations of it. And 356 00:20:05,240 --> 00:20:07,239 Speaker 1: you know, you're obviously the expert and correct me if 357 00:20:07,280 --> 00:20:09,679 Speaker 1: I'm wrong, but my impression is that a lot of 358 00:20:09,680 --> 00:20:13,679 Speaker 1: this is untested in courts, and as you just pointed 359 00:20:13,680 --> 00:20:17,159 Speaker 1: out on the non compete clauses that you know, you 360 00:20:17,240 --> 00:20:20,439 Speaker 1: could maybe fix some of this through new rule making, 361 00:20:20,480 --> 00:20:22,840 Speaker 1: but otherwise you're going to have to pursue it through 362 00:20:22,920 --> 00:20:26,840 Speaker 1: legal channels. So what exactly is the argument there, Like, 363 00:20:27,000 --> 00:20:31,160 Speaker 1: how do you get the courts to incorporate this idea 364 00:20:31,320 --> 00:20:32,320 Speaker 1: into existing law. 365 00:20:33,359 --> 00:20:37,000 Speaker 3: So the idea that anti trust laws protect everybody, including workers, 366 00:20:37,080 --> 00:20:41,439 Speaker 3: including competition in labor markets, is entirely accepted by the courts. 367 00:20:41,520 --> 00:20:43,800 Speaker 3: There was a few years ago a Supreme Court decision 368 00:20:43,960 --> 00:20:48,000 Speaker 3: and CAA v. Alston relating to student athletes, where the 369 00:20:48,000 --> 00:20:51,359 Speaker 3: court you know, reaffirmed the idea that anti trust laws 370 00:20:51,400 --> 00:20:54,160 Speaker 3: protect competition on the whole set of sides of the market. 371 00:20:54,640 --> 00:20:57,680 Speaker 3: And just recently, the Justice Department prevailed in a case 372 00:20:58,080 --> 00:21:01,040 Speaker 3: that they brought against publishers that were seeking to merge, 373 00:21:01,359 --> 00:21:03,600 Speaker 3: and one of the arguments they advanced there was that 374 00:21:03,600 --> 00:21:06,640 Speaker 3: that merger would have depressed the payments that are made 375 00:21:06,680 --> 00:21:09,919 Speaker 3: to authors. And so they again were looking at you know, 376 00:21:10,000 --> 00:21:13,159 Speaker 3: sides of the market other than end consumers. And you know, 377 00:21:13,200 --> 00:21:16,439 Speaker 3: there again that that idea also prevailed. So you know, 378 00:21:16,840 --> 00:21:20,159 Speaker 3: I believe we're you know, returning to faithful interpretations of 379 00:21:20,200 --> 00:21:23,479 Speaker 3: the law which are accepted by courts. And on you know, 380 00:21:23,520 --> 00:21:25,760 Speaker 3: the non compete side, for example, a lot of the 381 00:21:25,800 --> 00:21:29,280 Speaker 3: comments that we've gotten are also from healthcare workers, and 382 00:21:29,359 --> 00:21:32,199 Speaker 3: so something that we heard, for example, was that the 383 00:21:32,320 --> 00:21:36,000 Speaker 3: use of non competes during the pandemic really impeded the 384 00:21:36,040 --> 00:21:39,680 Speaker 3: ability of physicians to move. And this was a moment 385 00:21:39,720 --> 00:21:42,200 Speaker 3: in time where you know, you had outbreaks at different 386 00:21:42,520 --> 00:21:46,399 Speaker 3: cities and different regions, and so doctors and healthcare workers 387 00:21:46,480 --> 00:21:48,360 Speaker 3: wanted to be mobile, right, they wanted to be able 388 00:21:48,400 --> 00:21:52,880 Speaker 3: to go where COVID was really breaking out, and they 389 00:21:52,920 --> 00:21:56,040 Speaker 3: found that they weren't able to move easily and some 390 00:21:56,080 --> 00:21:58,800 Speaker 3: instances at all because of these non competes. And so 391 00:21:58,880 --> 00:22:02,160 Speaker 3: you see again in a verry real material way, how 392 00:22:02,280 --> 00:22:05,119 Speaker 3: this is not just about abstract debates with you know, 393 00:22:05,200 --> 00:22:08,280 Speaker 3: various labels tacked on, but really just you know, real 394 00:22:08,320 --> 00:22:09,720 Speaker 3: life impact I have. 395 00:22:10,359 --> 00:22:13,200 Speaker 2: It's kind of a philosophical question that I've been thinking 396 00:22:13,200 --> 00:22:16,000 Speaker 2: about a lot since we interviewed your sort of counterpart 397 00:22:16,119 --> 00:22:18,880 Speaker 2: over it, the DOJ. You know, when I think about 398 00:22:18,880 --> 00:22:22,720 Speaker 2: the broader economic agenda of the Biden administration, you don't, 399 00:22:22,840 --> 00:22:25,159 Speaker 2: you know, And many commenters have talked about this is 400 00:22:25,200 --> 00:22:29,719 Speaker 2: this sort of turn away against sort of neoliberalism, turnaway 401 00:22:29,760 --> 00:22:32,600 Speaker 2: against the sort of assumption that the market is best. 402 00:22:32,600 --> 00:22:34,760 Speaker 2: And so we have these big subsidies that are going 403 00:22:34,800 --> 00:22:37,720 Speaker 2: towards the big domestic agendas, and some could even say 404 00:22:37,720 --> 00:22:40,240 Speaker 2: we're picking winners and picking losers in a way. And yet, 405 00:22:40,600 --> 00:22:44,520 Speaker 2: thinking about your anti trust work, you know, competition always 406 00:22:44,520 --> 00:22:47,160 Speaker 2: seems like a good thing. It is like mom apple pie, 407 00:22:47,440 --> 00:22:50,200 Speaker 2: the American flag and competition, like, no one's against competition. 408 00:22:50,440 --> 00:22:53,080 Speaker 2: But I wonder like how it fits in this sort 409 00:22:53,119 --> 00:22:57,160 Speaker 2: of economic moment in which policy seems to be moving 410 00:22:57,160 --> 00:22:59,560 Speaker 2: in other realms away from the market knows best, and 411 00:22:59,600 --> 00:23:03,080 Speaker 2: so you're sort of pursuing this idea that competition is 412 00:23:03,119 --> 00:23:05,119 Speaker 2: this sort of per se good or its sort of 413 00:23:05,200 --> 00:23:08,119 Speaker 2: a north start of pursue at a time when a 414 00:23:08,160 --> 00:23:11,639 Speaker 2: lot of the economic policy making seems to be skeptical 415 00:23:11,680 --> 00:23:14,520 Speaker 2: a lot of traditional ideas of what makes a good market. 416 00:23:15,520 --> 00:23:19,400 Speaker 3: So, anti trust and competition policy is really about setting 417 00:23:19,800 --> 00:23:24,359 Speaker 3: the rules of the market, right. Antitrust and the ftc 418 00:23:24,480 --> 00:23:28,879 Speaker 3: act are really about distinguishing between fair and unfair methods 419 00:23:28,920 --> 00:23:32,760 Speaker 3: of competition. Right, So, are you able to compete by 420 00:23:33,040 --> 00:23:36,879 Speaker 3: burning down your competitors storefront? Right? Are you able to 421 00:23:36,920 --> 00:23:40,560 Speaker 3: compete by engaging in certain types of exploitative or predatory 422 00:23:40,720 --> 00:23:44,520 Speaker 3: practices or just buying out all of your rivals? No, 423 00:23:44,600 --> 00:23:47,840 Speaker 3: I mean those are unlawful means of competing. There are 424 00:23:47,880 --> 00:23:51,560 Speaker 3: other means of competing that are entirely lawful. Right, investing 425 00:23:51,800 --> 00:23:58,160 Speaker 3: in your facilities, investing in your workers, developing real operational efficiencies. 426 00:23:58,400 --> 00:24:00,959 Speaker 3: I mean, these are all mechanisms of competing that are 427 00:24:01,080 --> 00:24:04,280 Speaker 3: fair game. And so that's really where anti trust fits in. 428 00:24:04,920 --> 00:24:09,080 Speaker 3: I think one area where you do see some analogues 429 00:24:09,119 --> 00:24:12,600 Speaker 3: between some of the you know, rethinking that's happening is 430 00:24:13,480 --> 00:24:17,440 Speaker 3: where we are revisiting some of the core assumptions that 431 00:24:17,480 --> 00:24:21,359 Speaker 3: started to be baked in in stay the late seventies 432 00:24:21,400 --> 00:24:25,800 Speaker 3: and eighties and in antitrust. Those assumptions were really around 433 00:24:26,520 --> 00:24:30,840 Speaker 3: the idea that monopoly power would generally be fleeting, because 434 00:24:30,880 --> 00:24:33,920 Speaker 3: if a monopoly tried to exercise its power by say, 435 00:24:34,040 --> 00:24:37,720 Speaker 3: raising prices, you would immediately see this flood of new 436 00:24:37,760 --> 00:24:41,359 Speaker 3: competitors that would come in and discipline away that monopoly power. 437 00:24:41,640 --> 00:24:45,280 Speaker 3: And there was this idea that, you know, there's always uncertainty, 438 00:24:45,400 --> 00:24:48,240 Speaker 3: and so in the face of that uncertainty, the government 439 00:24:48,280 --> 00:24:51,320 Speaker 3: should err on the side of being hands off, because 440 00:24:51,400 --> 00:24:56,840 Speaker 3: government inaction that erroneously allowed monopoly power to flourish would 441 00:24:56,840 --> 00:25:01,160 Speaker 3: be disciplined and fixed by the market, where as government 442 00:25:01,560 --> 00:25:03,840 Speaker 3: errors on the side of enforcing the law would be 443 00:25:03,920 --> 00:25:06,800 Speaker 3: much stickier and difficult to get new legislation passed or 444 00:25:06,840 --> 00:25:10,119 Speaker 3: you know, court rulings overturn. And so that basic what 445 00:25:10,119 --> 00:25:12,840 Speaker 3: it's known as kind of the error cost analysis, that like, 446 00:25:13,080 --> 00:25:16,120 Speaker 3: when in doubt, government should stay out and not do anything, 447 00:25:16,280 --> 00:25:19,200 Speaker 3: was kind of baked in. So the approach the agencies 448 00:25:19,240 --> 00:25:21,760 Speaker 3: took to you know, a whole set of court decisions. 449 00:25:22,000 --> 00:25:24,800 Speaker 3: And that's really but what's being revisited this idea, this 450 00:25:24,800 --> 00:25:27,840 Speaker 3: whole set of you know, neo classical assumptions baked in 451 00:25:28,160 --> 00:25:31,439 Speaker 3: that just say the market will self correct. And you know, 452 00:25:31,600 --> 00:25:35,600 Speaker 3: the Biden administration, through the executive order, the President actually 453 00:25:35,640 --> 00:25:38,320 Speaker 3: even said in his speech, you know, we've been living 454 00:25:38,400 --> 00:25:41,919 Speaker 3: for forty years under this natural experiment, and the signs 455 00:25:41,920 --> 00:25:44,640 Speaker 3: are all around us that this natural experiment has failed. 456 00:25:45,000 --> 00:25:48,280 Speaker 3: We see too little competition in all these sectors. Americans 457 00:25:48,320 --> 00:25:52,280 Speaker 3: are paying more, they're making less money. We're seeing innovation declined. 458 00:25:52,280 --> 00:25:55,359 Speaker 3: They're all these material harms. And so that's where we 459 00:25:55,440 --> 00:25:58,359 Speaker 3: need to reinvigorate. We need to dispel with this notion 460 00:25:58,520 --> 00:26:00,919 Speaker 3: that the best n anti trust is no anti trust, 461 00:26:01,000 --> 00:26:14,639 Speaker 3: and we actually need to faithfully enforce the laws. 462 00:26:19,680 --> 00:26:22,560 Speaker 1: Joe, remind me to tell you about my first experience 463 00:26:22,600 --> 00:26:24,359 Speaker 1: with American health care. 464 00:26:25,840 --> 00:26:27,320 Speaker 2: Yeah, you can talk about it. 465 00:26:27,520 --> 00:26:29,960 Speaker 1: But just on this point. You know, some of the 466 00:26:30,000 --> 00:26:32,800 Speaker 1: criticism that we've seen, and I really I hate to 467 00:26:32,880 --> 00:26:37,080 Speaker 1: keep quoting headlines from competing media outlets, but for instance, 468 00:26:37,160 --> 00:26:39,440 Speaker 1: there was a Wall Street Journal op ed that had 469 00:26:39,520 --> 00:26:45,600 Speaker 1: a very unsubtle headline of Lenacon blocks cancer cures, And 470 00:26:45,840 --> 00:26:48,359 Speaker 1: I guess the question is, you know, the argument there 471 00:26:48,560 --> 00:26:53,320 Speaker 1: is by making people think twice about investing in certain 472 00:26:53,359 --> 00:26:56,760 Speaker 1: medical businesses, maybe you're cutting off a source of capital 473 00:26:57,000 --> 00:26:59,959 Speaker 1: for a very capital intensive industry. It takes a lot 474 00:27:00,040 --> 00:27:03,320 Speaker 1: lot of money to research new medicines, new treatments, build 475 00:27:03,359 --> 00:27:07,119 Speaker 1: new facilities or whatever. So how do you balance the 476 00:27:07,240 --> 00:27:11,359 Speaker 1: need to fund new and innovative medical treatments, in other words, 477 00:27:11,359 --> 00:27:14,760 Speaker 1: the need to get money into this industry with the 478 00:27:14,880 --> 00:27:18,080 Speaker 1: desire to ensure fair and competitive markets. 479 00:27:18,480 --> 00:27:22,080 Speaker 3: So, look, we always consider every particular deal on its 480 00:27:22,080 --> 00:27:25,199 Speaker 3: specific facts, on a case by case basis. I believe 481 00:27:25,280 --> 00:27:28,679 Speaker 3: the merger that that op ed is referencing was actually 482 00:27:28,760 --> 00:27:31,320 Speaker 3: voted out before I've even arrived at the FTC on 483 00:27:31,359 --> 00:27:34,000 Speaker 3: a unanimous basis. So I think sometimes there's a desire 484 00:27:34,080 --> 00:27:37,199 Speaker 3: to over attribute to me. But look, I think you know, 485 00:27:37,280 --> 00:27:40,560 Speaker 3: in the pharma space, for example, we often hear arguments 486 00:27:40,560 --> 00:27:43,840 Speaker 3: that are the only way for commercialization is to have, 487 00:27:43,920 --> 00:27:46,240 Speaker 3: you know, the big pharma companies buy out the small 488 00:27:46,359 --> 00:27:49,840 Speaker 3: pharma companies. And I think we've seen in practice that 489 00:27:50,200 --> 00:27:53,800 Speaker 3: you want to be able to maintain more exit opportunities 490 00:27:54,000 --> 00:27:57,200 Speaker 3: and so you know, even if you're talking about an 491 00:27:57,240 --> 00:28:01,760 Speaker 3: existing monopolist buying out a new pipeline drug that could 492 00:28:01,760 --> 00:28:04,720 Speaker 3: be a direct competitor, we think that's bad, right, And 493 00:28:04,760 --> 00:28:07,000 Speaker 3: there's research showing that we've seen what are known as 494 00:28:07,119 --> 00:28:10,040 Speaker 3: kill our acquisitions in the pharma space in particular, where 495 00:28:10,080 --> 00:28:14,040 Speaker 3: you have these buyouts and ultimately the acquiring firm shuts 496 00:28:14,119 --> 00:28:17,040 Speaker 3: down what was, you know, a pipeline drug or an 497 00:28:17,119 --> 00:28:20,240 Speaker 3: existing area of R and D because it risked cannibalizing 498 00:28:20,320 --> 00:28:23,440 Speaker 3: some of their existing drugs. The FTC also brought a 499 00:28:23,520 --> 00:28:28,560 Speaker 3: lawsuit this summer against Amgen's acquisition of Horizon, and there 500 00:28:28,600 --> 00:28:30,920 Speaker 3: we were really building on the fact that Amgen had 501 00:28:30,920 --> 00:28:34,359 Speaker 3: a history of engaging in some of these exclusionary cross 502 00:28:34,400 --> 00:28:38,520 Speaker 3: bundling tactics where they would use their existing portfolio of 503 00:28:38,600 --> 00:28:43,480 Speaker 3: blockbuster drugs as anchors to secure more favorable treatment or 504 00:28:43,560 --> 00:28:47,240 Speaker 3: placement by PBMs for some of their non blockbuster drugs, 505 00:28:47,280 --> 00:28:50,440 Speaker 3: and that that could have a real exclusionary and anti 506 00:28:50,440 --> 00:28:54,160 Speaker 3: competitive effect in ways that again is about ensuring that 507 00:28:54,200 --> 00:28:57,280 Speaker 3: Americans have more affordable access to healthcare. And so, you know, 508 00:28:57,320 --> 00:29:01,760 Speaker 3: the Horizon drugs that they were buyingstek to Pezza, these 509 00:29:01,800 --> 00:29:06,320 Speaker 3: are addressing you know, special types of gout illnesses, special 510 00:29:06,400 --> 00:29:10,120 Speaker 3: type of dioid illnesses. These are drugs that cost you know, 511 00:29:10,200 --> 00:29:13,640 Speaker 3: anywhere from four hundred thousand to six hundred thousand dollars 512 00:29:13,640 --> 00:29:16,680 Speaker 3: for a six month treatment. And so whether an acquisition 513 00:29:16,800 --> 00:29:20,440 Speaker 3: is allowing a firm to fend off new rivals, fend 514 00:29:20,440 --> 00:29:23,360 Speaker 3: off you know, generics or biosimilars from the market and 515 00:29:23,480 --> 00:29:27,040 Speaker 3: keep prices high has a real material effect on people. 516 00:29:27,080 --> 00:29:29,200 Speaker 3: And so that's why we take you know, enforcement in 517 00:29:29,240 --> 00:29:30,440 Speaker 3: these areas so seriously. 518 00:29:31,280 --> 00:29:34,080 Speaker 2: Just going back real quickly to the lawsuit that we 519 00:29:34,320 --> 00:29:38,160 Speaker 2: started the conversation with the actions that you are alleging 520 00:29:38,240 --> 00:29:42,080 Speaker 2: or engaged in by USAP, and they're backing pe from Walsh, Carson, 521 00:29:42,240 --> 00:29:45,120 Speaker 2: Anderson and Stowe. Is it your belief or is it 522 00:29:45,160 --> 00:29:48,520 Speaker 2: your sense that the basic playbook that they used is 523 00:29:48,600 --> 00:29:51,160 Speaker 2: not confined to them, that there are many of these 524 00:29:51,400 --> 00:29:54,880 Speaker 2: essentially same strategies that have been employed maybe in anesthesia 525 00:29:54,960 --> 00:29:58,600 Speaker 2: or other realms within healthcare around the country that at 526 00:29:58,600 --> 00:30:00,680 Speaker 2: some point maybe we're looking into. 527 00:30:02,640 --> 00:30:04,720 Speaker 3: How you need Yeah, I mean, we wouldn't want to 528 00:30:04,760 --> 00:30:08,720 Speaker 3: prejudge anything before you know, actually doing a real investigation, 529 00:30:08,960 --> 00:30:12,200 Speaker 3: but I will say, both after this lawsuit, we've started 530 00:30:12,240 --> 00:30:15,400 Speaker 3: hearing a lot from you know, healthcare workers and doctors 531 00:30:15,520 --> 00:30:19,320 Speaker 3: and folks in healthcare who are pointing to other specialties 532 00:30:19,360 --> 00:30:22,680 Speaker 3: in particular that they believe have similarly been rolled up, 533 00:30:22,720 --> 00:30:26,600 Speaker 3: potentially unlawfully. We also, when we put out our draft 534 00:30:26,640 --> 00:30:30,200 Speaker 3: merger guidelines, we got thousands and thousands of comments, a 535 00:30:30,240 --> 00:30:34,120 Speaker 3: lot of those also from healthcare workers, again identifying areas 536 00:30:34,160 --> 00:30:36,840 Speaker 3: where they believe we may have seen serial acquisitions or 537 00:30:36,920 --> 00:30:39,840 Speaker 3: roll up. So, based on what we're hearing from the market, 538 00:30:40,160 --> 00:30:43,200 Speaker 3: it certainly seems that this might not be an isolated strategy. 539 00:30:43,840 --> 00:30:47,320 Speaker 1: Does the FTC have to win its suits to be effective, 540 00:30:47,800 --> 00:30:50,479 Speaker 1: or you know, is the threat of legal action in 541 00:30:50,560 --> 00:30:55,360 Speaker 1: and of itself a deterrent to monopolistic practices? Or if 542 00:30:55,400 --> 00:30:58,480 Speaker 1: companies see the FTC losing in court, do they become 543 00:30:58,560 --> 00:30:59,720 Speaker 1: more emboldened. 544 00:31:00,520 --> 00:31:03,040 Speaker 3: So, look, we only bring lawsuits where we believe there's 545 00:31:03,080 --> 00:31:06,040 Speaker 3: a law violation, and we bring lawsuits because we want 546 00:31:06,040 --> 00:31:09,200 Speaker 3: to win. One area where I've been really pleased with 547 00:31:09,240 --> 00:31:13,040 Speaker 3: our impact is deterrence. Right, as a law enforcer, you 548 00:31:13,080 --> 00:31:16,080 Speaker 3: want to make sure that firms are not engaging in 549 00:31:16,200 --> 00:31:19,440 Speaker 3: law violations in the first place. And one thing we've 550 00:31:19,480 --> 00:31:23,240 Speaker 3: heard from you know, senior deal makers, senior anti trust lawyers, 551 00:31:23,520 --> 00:31:26,160 Speaker 3: is that even a few years ago, when there were 552 00:31:26,280 --> 00:31:30,400 Speaker 3: initial deal discussions, anti trust risk would not be among 553 00:31:30,560 --> 00:31:33,520 Speaker 3: like the list of things that would initially get discussed, right, 554 00:31:33,560 --> 00:31:35,200 Speaker 3: It might come up in the middle of the deal, 555 00:31:35,440 --> 00:31:38,800 Speaker 3: or more often at the very end. And these senior 556 00:31:38,880 --> 00:31:42,440 Speaker 3: deal makers are acknowledging that that's totally changed, Right, anti 557 00:31:42,440 --> 00:31:45,640 Speaker 3: trust risk is now talked about at the very beginning. 558 00:31:46,040 --> 00:31:49,640 Speaker 3: And as an enforcer, you want entities to be thinking 559 00:31:49,680 --> 00:31:52,200 Speaker 3: about how do we not break the law? Right, that's 560 00:31:52,400 --> 00:31:55,840 Speaker 3: good for enforcement, it's good for taxpayers, and so from 561 00:31:55,840 --> 00:31:59,080 Speaker 3: a deterrence perspective, we're quite please and happy and think 562 00:31:59,080 --> 00:32:02,320 Speaker 3: it's reflective of a functioning law enforcement system and of 563 00:32:02,600 --> 00:32:05,480 Speaker 3: a rule of law system to make sure that entities 564 00:32:05,520 --> 00:32:07,400 Speaker 3: are thinking about that type of risk initially. 565 00:32:07,680 --> 00:32:10,760 Speaker 1: So no more putting chiching in company presentations. 566 00:32:10,800 --> 00:32:13,720 Speaker 2: I guess, Billy, when you say that these antitrust concern 567 00:32:13,840 --> 00:32:16,640 Speaker 2: is happening very early on in the conversation among dealmakers, 568 00:32:16,800 --> 00:32:18,920 Speaker 2: where is that being aired? Is that something people are 569 00:32:18,920 --> 00:32:21,080 Speaker 2: telling you, Is that something people are writing about? How 570 00:32:21,080 --> 00:32:21,920 Speaker 2: do you actually see that? 571 00:32:22,440 --> 00:32:25,280 Speaker 3: So we've had people tell us that directly. We've also seen, 572 00:32:25,360 --> 00:32:28,360 Speaker 3: you know, senior heads of divisions of investment banks go 573 00:32:28,480 --> 00:32:31,120 Speaker 3: on TV and you know, share that quite publicly. 574 00:32:31,680 --> 00:32:34,360 Speaker 1: I have just one more question, and it's an extremely 575 00:32:34,400 --> 00:32:37,440 Speaker 1: important one, and listeners of this podcast note that whenever 576 00:32:37,440 --> 00:32:40,680 Speaker 1: there's an opportunity to bring chickens into the conversation, I 577 00:32:40,760 --> 00:32:43,000 Speaker 1: will seize on it. But Joe and I heard that 578 00:32:43,080 --> 00:32:45,800 Speaker 1: you might have a background in poultry. 579 00:32:47,240 --> 00:32:49,560 Speaker 3: That's right. So I got my start in anti trust 580 00:32:49,960 --> 00:32:51,960 Speaker 3: in part as a business journalist, and one of my 581 00:32:52,000 --> 00:32:55,600 Speaker 3: first assignments was to look at the poultry market. The 582 00:32:55,640 --> 00:32:59,000 Speaker 3: poultry market is an area where we've seen significant consolidation 583 00:32:59,160 --> 00:33:01,360 Speaker 3: over the last few day decades, and so you have 584 00:33:01,440 --> 00:33:04,360 Speaker 3: millions of consumers, you have thousands of farmers, but they're 585 00:33:04,400 --> 00:33:07,440 Speaker 3: all just connected by a very small number of chicken 586 00:33:07,480 --> 00:33:10,840 Speaker 3: processing companies. And you know, we've heard a lot over 587 00:33:10,880 --> 00:33:14,080 Speaker 3: the years from chicken farmers about how this market may 588 00:33:14,120 --> 00:33:18,600 Speaker 3: be enabling coercive and potentially anti competitive practices. We've also 589 00:33:18,640 --> 00:33:23,360 Speaker 3: seen empirical research suggesting that consumers are paying more, chicken 590 00:33:23,400 --> 00:33:25,880 Speaker 3: farmers are making less, and so it may be the 591 00:33:25,920 --> 00:33:28,080 Speaker 3: companies in the middle that are just taking a bigger 592 00:33:28,120 --> 00:33:29,000 Speaker 3: and bigger share. 593 00:33:29,360 --> 00:33:33,640 Speaker 2: Tracy, if being a journalist stepping stone to this, then 594 00:33:33,840 --> 00:33:35,400 Speaker 2: maybe one day that it could be this could be 595 00:33:35,440 --> 00:33:35,840 Speaker 2: one of us. 596 00:33:35,880 --> 00:33:38,840 Speaker 1: This is a very motivational need to do as well 597 00:33:38,880 --> 00:33:41,880 Speaker 1: as Lena Kahn. Okay, well, Lena, that was amazing. Thank 598 00:33:41,920 --> 00:33:44,480 Speaker 1: you so much for coming on odd lots and explaining 599 00:33:44,480 --> 00:33:46,800 Speaker 1: the way you're thinking about anti trust at the moment. 600 00:33:47,080 --> 00:33:48,800 Speaker 1: Thank you well, so nice to meet you both. 601 00:33:48,840 --> 00:33:53,200 Speaker 3: You're kind of like legends and you know podcast World producers. 602 00:33:53,320 --> 00:34:10,839 Speaker 1: Are you still recording? Joe? That was fun. Any conversation 603 00:34:10,920 --> 00:34:16,680 Speaker 1: that includes both Monopsony and chickens I am a major 604 00:34:16,719 --> 00:34:17,080 Speaker 1: fan of. 605 00:34:17,440 --> 00:34:21,080 Speaker 2: That was a great conversation. There were so many interesting aspects. 606 00:34:21,120 --> 00:34:22,960 Speaker 2: I mean, one thing that I really appreciate and I 607 00:34:23,000 --> 00:34:25,240 Speaker 2: said it and it really comes throughing the complaint against 608 00:34:25,320 --> 00:34:28,000 Speaker 2: USAP and it makes sense. I mean, lawyers aren't just 609 00:34:28,000 --> 00:34:30,400 Speaker 2: going to bring a case without understanding the industry, but 610 00:34:30,840 --> 00:34:34,960 Speaker 2: the sort of details about how these industries really operate 611 00:34:35,280 --> 00:34:38,919 Speaker 2: and the different business models there. And I can only imagine, 612 00:34:39,200 --> 00:34:41,400 Speaker 2: I don't know, the tip line that they must be 613 00:34:41,400 --> 00:34:44,799 Speaker 2: getting flooded with at the FTC of frustrated doctors and 614 00:34:44,840 --> 00:34:48,800 Speaker 2: frustrated healthcare workers as they watch, you know, themselves working 615 00:34:48,840 --> 00:34:50,600 Speaker 2: for larger and larger corporate entities. 616 00:34:50,760 --> 00:34:53,759 Speaker 1: Well, I kept thinking maybe FTC staffers would make really 617 00:34:53,760 --> 00:34:55,840 Speaker 1: good all thoughts guests. I wonder if they would come 618 00:34:55,880 --> 00:34:57,800 Speaker 1: on and talk about, you know, how they're thinking about 619 00:34:57,800 --> 00:34:58,800 Speaker 1: specific industries. 620 00:34:58,960 --> 00:35:00,719 Speaker 2: You know what I do think we should definitely get 621 00:35:00,760 --> 00:35:04,200 Speaker 2: I mean a yes would be I think this corporate 622 00:35:04,239 --> 00:35:06,719 Speaker 2: practice of medicine I mentioned there's this really good I 623 00:35:06,840 --> 00:35:10,319 Speaker 2: mentioned it by Motagic at the American Prospect. You know, 624 00:35:10,360 --> 00:35:12,920 Speaker 2: the AMA for years that one of their big things 625 00:35:13,080 --> 00:35:16,160 Speaker 2: was sort of fighting against socialized medicine and things like that, 626 00:35:16,760 --> 00:35:20,640 Speaker 2: and now they're complaining about corporatized medicine, And so what 627 00:35:20,719 --> 00:35:22,400 Speaker 2: is it like to be a doctor in the year 628 00:35:22,440 --> 00:35:26,319 Speaker 2: twenty twenty three versus I don't know, nineteen ninety three, 629 00:35:26,680 --> 00:35:31,239 Speaker 2: as these large private equity firms and other large corporations 630 00:35:31,239 --> 00:35:34,120 Speaker 2: are your bosses. Would sort of be a very interesting episode, 631 00:35:34,160 --> 00:35:34,560 Speaker 2: I think. 632 00:35:34,400 --> 00:35:36,719 Speaker 1: For us absolutely, and I'd be really interested in it 633 00:35:36,719 --> 00:35:38,719 Speaker 1: because you know, I have a confession to make, which 634 00:35:38,760 --> 00:35:42,200 Speaker 1: is I still don't understand how US healthcare works at all, 635 00:35:42,800 --> 00:35:45,160 Speaker 1: Like it is just massively confusing. My plan is to 636 00:35:45,280 --> 00:35:48,640 Speaker 1: never get sick, never have to go to a doctor 637 00:35:49,040 --> 00:35:51,799 Speaker 1: or a hospital ever because I can't figure it out. 638 00:35:51,880 --> 00:35:54,680 Speaker 2: Yeah, you literally can't. I So I recently this summer, 639 00:35:55,080 --> 00:35:58,520 Speaker 2: I had a minor it was weird leg injury. 640 00:35:58,560 --> 00:35:59,600 Speaker 1: It was fine, but. 641 00:35:59,600 --> 00:36:02,879 Speaker 2: I went this hospital. It was fine, and they took 642 00:36:02,960 --> 00:36:04,680 Speaker 2: care of it in a day. And then I got 643 00:36:04,680 --> 00:36:06,560 Speaker 2: a bill. And the bill was actually not that big, 644 00:36:06,800 --> 00:36:09,800 Speaker 2: but in my mind, the bill could have been anywhere 645 00:36:09,840 --> 00:36:14,360 Speaker 2: from seventy five dollars copay to twenty thousand dollars and 646 00:36:14,400 --> 00:36:17,239 Speaker 2: I would have had no idea at any point what 647 00:36:17,280 --> 00:36:18,960 Speaker 2: I was going to pay. Just sort of a mirrorgly 648 00:36:19,040 --> 00:36:20,440 Speaker 2: But how would I have any idea? And I just 649 00:36:20,480 --> 00:36:22,960 Speaker 2: think that you just sort of enter in randomly to 650 00:36:23,000 --> 00:36:25,200 Speaker 2: the US healthcare system and then it feels like you're 651 00:36:25,280 --> 00:36:25,719 Speaker 2: rolling dick. 652 00:36:26,000 --> 00:36:28,400 Speaker 1: Well, this is what I wanted to mention. So the 653 00:36:28,520 --> 00:36:30,960 Speaker 1: first time I came to the States as a sort 654 00:36:30,960 --> 00:36:34,840 Speaker 1: of working person was twenty twelve, I think, and I 655 00:36:34,920 --> 00:36:37,719 Speaker 1: went to get a prescription for a medicine that I 656 00:36:37,760 --> 00:36:41,080 Speaker 1: had gotten for free for more than ten years in 657 00:36:41,120 --> 00:36:44,320 Speaker 1: the UK, and I left with an eight hundred dollars 658 00:36:44,440 --> 00:36:49,200 Speaker 1: tab as an insured person, and it took months to 659 00:36:49,320 --> 00:36:52,640 Speaker 1: sort it out with insurance. And I was so shocked 660 00:36:52,760 --> 00:36:56,960 Speaker 1: that A this could even happen, and b that because 661 00:36:56,960 --> 00:36:59,400 Speaker 1: of the way the US healthcare system worked, that it 662 00:36:59,440 --> 00:37:02,920 Speaker 1: was suddenly compent on me to make a billion phone 663 00:37:02,920 --> 00:37:06,120 Speaker 1: calls to both the insurance company and the doctor to 664 00:37:06,440 --> 00:37:09,120 Speaker 1: argue about this fee. It just blew my mind. 665 00:37:09,239 --> 00:37:12,919 Speaker 2: So one thing again, in this complaint against USAP, there's 666 00:37:12,920 --> 00:37:15,439 Speaker 2: this whole conversation and it's sort of wild to think 667 00:37:15,440 --> 00:37:18,960 Speaker 2: about that you could go into a hospital, the surgeon 668 00:37:19,280 --> 00:37:21,719 Speaker 2: could be in your network and insured, and you don't 669 00:37:21,760 --> 00:37:24,160 Speaker 2: even think, oh, but what if the anesthesiologist who you 670 00:37:24,239 --> 00:37:26,359 Speaker 2: just think part of the package, right, you don't really 671 00:37:26,400 --> 00:37:29,200 Speaker 2: think I'm getting don't competition? 672 00:37:29,719 --> 00:37:31,799 Speaker 1: Well. The classic example is also if you get run 673 00:37:31,800 --> 00:37:33,960 Speaker 1: over in the street and you're unconscious, you have no 674 00:37:34,120 --> 00:37:36,640 Speaker 1: say in what hospital they're bringing you to. 675 00:37:37,000 --> 00:37:38,960 Speaker 2: I mean, there's a lot to do with what a 676 00:37:39,000 --> 00:37:42,040 Speaker 2: mess this is. So I do think that from a 677 00:37:42,120 --> 00:37:47,600 Speaker 2: broader macro priorities of the United States standpoint, it is 678 00:37:48,480 --> 00:37:50,239 Speaker 2: a belief that I have is we would be very 679 00:37:50,280 --> 00:37:55,360 Speaker 2: good if we could just continue to pursue general exploitation 680 00:37:55,520 --> 00:37:56,960 Speaker 2: and grift within the industry. 681 00:37:57,080 --> 00:37:58,200 Speaker 1: No, I totally that would be. 682 00:37:58,280 --> 00:38:00,400 Speaker 2: That would be a good goal, and if anti trust 683 00:38:00,840 --> 00:38:04,000 Speaker 2: enforcement is one way to pursue that, then that's. 684 00:38:03,760 --> 00:38:06,200 Speaker 1: Great, right. And this kind of gets to Lina's point 685 00:38:06,239 --> 00:38:09,520 Speaker 1: about we've had decades at this point to illustrate that 686 00:38:09,600 --> 00:38:12,800 Speaker 1: some aspects of the system aren't really working, and certainly 687 00:38:12,840 --> 00:38:16,479 Speaker 1: my experience would tally with that. But anyway, we could 688 00:38:16,480 --> 00:38:19,319 Speaker 1: go on and on about healthcare disasters for hours, but 689 00:38:19,360 --> 00:38:20,160 Speaker 1: shall we leave it there. 690 00:38:20,239 --> 00:38:21,399 Speaker 2: Let's leave it there, all right. 691 00:38:21,520 --> 00:38:24,520 Speaker 1: This has been another episode of the Oddlots podcast. I'm 692 00:38:24,560 --> 00:38:27,680 Speaker 1: Tracy Alloway. You can follow me at Tracy Alloway and. 693 00:38:27,640 --> 00:38:30,480 Speaker 2: I'm joll Wisenthal. You can follow me at the Stalwart. 694 00:38:30,680 --> 00:38:34,359 Speaker 2: Follow our guest Lina Kahn, She's at Lena Kahn FTC. 695 00:38:34,840 --> 00:38:38,440 Speaker 2: Follow our producers Carman Rodriguez at Carmen Arman, dash Ol 696 00:38:38,440 --> 00:38:42,120 Speaker 2: Bennett at Dashbot, and kel Brooks at Kelbrooks. And thank 697 00:38:42,160 --> 00:38:44,600 Speaker 2: you to our producer Modes. It's on them. And for 698 00:38:44,680 --> 00:38:48,040 Speaker 2: more Oddlogs content, go to Bloomberg dot com slash odd Logs. 699 00:38:48,440 --> 00:38:51,200 Speaker 2: We have transcripts, a blog, and a newsletter that comes 700 00:38:51,239 --> 00:38:53,520 Speaker 2: out every Friday. And I'm sure there will be a 701 00:38:53,560 --> 00:38:57,000 Speaker 2: lot of conversation about this episode in the Oddlogs Discord 702 00:38:57,120 --> 00:39:00,400 Speaker 2: Chat twenty four to seven with fellow listeners Discord do 703 00:39:01,080 --> 00:39:02,320 Speaker 2: Slash outline. 704 00:39:02,280 --> 00:39:04,759 Speaker 1: And if you enjoy odd Lots, if you want us 705 00:39:04,800 --> 00:39:07,640 Speaker 1: to do more on the medical and healthcare industry, then 706 00:39:07,719 --> 00:39:11,520 Speaker 1: please leave us a positive review on your favorite podcast platform. 707 00:39:11,560 --> 00:39:12,320 Speaker 1: Thanks for listening.