Nov 11, 2025
By JEFF GOLDSMITH
The well being coverage neighborhood is obsessive about hospital mergers. In a current paper which I critiqued, the working thesis was that hospital mergers are conspiracies in restraint of trade, enabling hospitals to extract lease from helpless native employers and sufferers. This logic leads on to advocacy (lavishly funded by Arnold Ventures philanthropy) of hospital rate controls as the one means of restraining this abuse of financial energy.
The truth is, as you may count on, considerably completely different. The next chart, courtesy of healthcare information agency Trilliant Well being, reveals that hospitals are actually incompetent monopolists. It reveals the correlation between hospital working margins and market focus for 2023. The hospitals to the far proper on this chart have 100% native market shares.
Supply: Trilliant Healthcare Evaluation of CMS HCRIS recordsdata (Hospital Value Experiences), 2023
Do you see a correlation? I positive don’t.
In line with Trilliant, the common hospital working margin in 336 CBSAs (markets) the place hospital companies are “managed by a single agency” is -1.7%.This damaging working margin common does NOT embrace the working losses on their doctor practices, which aren’t reported on hospital price reviews, so the precise working losses are doubtless a lot better.
Jeff Goldsmith is a veteran well being care futurist, President of Well being Futures Inc and common THCB Contributor. This comes from his personal substack
