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Over the past ten years, the University of Pittsburgh Medical Center (UPMC) has prioritized expansion and profit instead of care quality.

UPMC now owns forty hospitals, provides insurance to almost four million people and employs around 92,000 workers. The result is high prices, low wages, stressful working conditions and big profits for UPMC.

According to Pennsylvania State Representative Sara Innamorato (D-21) and U.S. Congresswoman Summer Lee (D-PA), “UPMC has abused the privileges afforded to it as a non-profit medical system to build a monopoly over healthcare in Western Pennsylvania.”

This comes from a recent report from the American Economic Liberties Project. The organization advocates for corporate accountability and anti-trust regulation. The group is funded in part by the Omidyar Network.

UPMC is using classic monopolistic and anti-competitive tactics to do what monopolies always do: Distort the market and use their power to earn enormous profits.

Its first tactic is consolidation. UPMC has aggressively expanded their share of the healthcare market in Western Pennsylvania, growing from twelve hospitals to forty in the past ten years. UPMC has even bought hospitals to shut them down and force patients to seek care at their already established facilities. UPMC Pinnacle Lancaster and UPMC Susquehanna Sunbury are examples of this.

According to the report, the Federal Trade Commission found that hospital mergers lead to “40-50 percent higher prices” and that “wages were 6.8 percent lower for nurses and pharmacy workers and 4 percent lower for non-medical […] workers than they would have been if the merger had never occurred.”

The second tactic is union-busting. UPMC depresses wages by ensuring its workers never unionize. Workers who attempt to organize a union are “surveilled, harassed, intimidated and ultimately fired,” according to the report.

UPMC has been sued by the National Labor Relations Board over 150 times and been found guilty of breaking federal labor law in 2014 and in 2018. The result is that only two percent of UPMC workers are members of a union. For comparison, 34 percent of Allegheny Health Network workers are unionized.

The lack of labor protections allows UPMC to overwork and underpay their workers. A recent survey reports that 93 percent of hospital staff in Pittsburgh think about quitting daily and 90 percent reported being behind on their workload.

The third tactic is abusing its role as an insurance provider.

The report reads, “UPMC controlled 17.5 percent of the health insurance market in Pennsylvania and 32 percent of the market in Western Pennsylvania. As a major insurer, it can use access to care to acquire new patients and harm its competitors.”

The report contains several recommendations on how to improve health care quality and working conditions.

Pennsylvania should pass the Pennsylvania Open Markets Act as the state lacks anti-trust regulations. The state should use these regulations to break up UPMC’s monopoly power.

The state should enforce stricter labor regulations to ensure that workers are free to form unions without harassment.

The state should ban non-compete agreements. Non-compete agreements prevent workers from working for competitors within a close geographic distance. Banning these agreements would give workers greater freedom to leave UPMC and seek better conditions elsewhere.

The state should reform or eliminate UPMC’s tax-exempt status as UPMC has violated its requirements to currently receive it.

The state should ban insurance-refusal. Currently, insurance companies are only accepted by certain hospitals in their network. A patient who has insurance that is not accepted by UPMC must pay the full price of their visit or travel a longer distance to a hospital that does accept their insurance. Forcing hospitals to accept all licensed insurers would help to break UPMC’s monopoly.

The issue with these solutions is that they are simply band aids on a fundamentally broken system. Running health care as a for-profit business hurts everybody. Creating greater competition may lower prices for UPMC, but it unnecessarily divides resources and will keep prices higher than they need to be for their patients. The only real solution is to treat health care as a public service, such as Canada and the United Kingdom, where hospitals are managed publicly. This allows them to serve anyone who needs care and to be held accountable.

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