The avocado you picked up at the grocery store almost certainly started its journey at a family farm in Mexico. From there, a packing company bought, sorted, and shipped it to the United States. Stateside, a distributor bought it and shipped it to the grocery store in your town. By the time you paid a dollar for that avocado, it had passed through the hands of perhaps four companies, each competing with several others for a slice of the fruit trade. That single dollar covered all the costs: growing, packing, shipping, displaying, and ringing it up at the checkout stand. Now think of something more personal, like the life-sustaining pill your mother takes to manage her chronic illness. That drug is manufactured by a pharmaceutical company. From there, it’s typically sold to a pharmacy benefit manager, shipped to a retail pharmacy, prescribed by a doctor, and ultimately paid for by an insurance company, Medicare or Medicaid. Like the avocado, the pill changes hands several times. However, there’s a crucial difference. In this case, every hand it passes through belongs to the same sprawling healthcare corporation. Even the doctor writing the prescription might be on that company’s payroll. Your $15 co-pay is just a small part of the cost you can see. Some experts argue that this model is a net win, but others see it differently. They argue that letting a handful of companies set prices for manufacturers and consumers alike smothers competition. This reduces patient choice, as these companies steer patients to their own services and drive up the cost of the medication people need to stay alive.
