THE AFFORDABILITY CRISIS Part 2

The affordability crisis in the U.S. is multifaceted and has been growing for 45 years, due to low pay and high prices. There are many factors pushing up prices well beyond normal inflation, including profit-taking middlemen and privatization of public goods and services.

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My previous post presented an overview of the affordability crisis in the U.S., its 45 year history, and began a discussion of why prices are so high. It covered:

·       Monopolistic price gouging,

·       Tariffs, and

·       Personalized (aka surveillance) pricing driven by artificial intelligence (AI).

This post will discuss:

·       Profit-taking by middlemen (aka intermediaries) from ticket sellers to drug benefit managers that increases costs for consumers, often unjustifiably and even illegally.

·       Privatization and the fraud that often accompanies it leave consumers and taxpayers with higher costs and often degraded quality.

Middlemen, also referred to as intermediaries, are entities that operate between consumers and the producers of goods or services. Ostensibly, they make the market operate more efficiently by linking consumers and producers, while making transactions easier and smoother. However, given their need to make a profit, they often end up more focused on profit-making than helping markets operate efficiently. They add a layer of costs to consumers’ purchases, pushing up prices. [1]

Pharmacy Benefit Managers (PBMs) are a classic example of  middlemen. The original intent was to reduce drug costs, saving insurers and consumers money, but that has morphed into rapacious profit making by manipulating the market and increasing drug costs for consumers. PBMs manage drug benefits for insurance companies and largely determine which drugs are available to insurees and how much they will pay for them. There are three huge, monopolistic PBMs that manage the great majority of drug benefits for private insurers, which is a $600 billion global market. They have found that they can be very profitable by negotiating kickbacks from drug manufacturers (that may be half the cost of a drug) for the drugs they include in an insurer’s formulary, i.e., the list of insured drugs and how much consumers must pay for them. They also sign contracts with pharmacies that tend to reward the big chains and make it very hard for independent pharmacies to exist. It’s estimated that 42 cents of every dollar paid for prescription drugs now goes to a PBM. Meanwhile, the PBM industry spends over $10 million a year lobbying the federal government to block regulation. [2]

As with the PBMs, other monopolistic middlemen often find ways to manipulate the market to make big profits by not only increasing prices for consumers but also lowering the prices they pay to producers. Amazon, once it gained monopolistic control of various e-commerce sectors, has shown itself to be a master at squeezing producers to minimize costs, while also figuring out ways to maximize its revenue from consumers.

Live Nation (parent company of Ticket Master) is another example of a monopolistic middleman. It dominates ticket sales for entertainment events and jacks up prices and adds junk fees to boost its profits. It has increased its monopolistic power by also managing thousands of performers and purchasing many entertainment venues. [3]

Middlemen, from Wall St. asset managers and stock traders to real estate agents, eBay, and the apps that deliver food to your door, add their costs and profits to transactions, thereby increasing prices for consumers. Some have been found to engage in illegal or at least unethical ways to increase their profits.

Meat packers are middlemen that buy meat from ranchers and farmers, process it, and sell it to consumer outlets, e.g., supermarkets. There are four giant meat packers that engage in monopolistic practices, both in the buying and the selling of meat. This, and illegal collusion, has led them to be very profitable as prices for consumers have increased dramatically while the prices they pay to meat producers have fallen. In October 2025, the meatpackers settled two separate price-fixing lawsuits for almost $300 million for illegally jacking up the prices of beef and pork.

As with middlemen, the privatization of goods and services typically delivered by government is presented as a way to make markets more efficient. There are many examples such as privatization of Medicare, roads and bridges with private tolls, and electricity, water, and sewer systems operated by private entities. Often, the profit motive leads to increased costs for consumers and decreased quality of the goods or services delivered.

For example, the federal government has allowed the privatization of the delivery of Medicare health care services to seniors through what are called Medicare Advantage plans. They are run by private insurers and are very profitable because they make it hard to get some health care services (especially expensive ones) and because they cheat the federal government. They cost more than traditional, publicly provided Medicare and deliver worse outcomes. It is estimated that Medicare would save at least $75 billion a year by eliminating Medicare Advantage plans. Because taxpayers pay for Medicare, they are driving up the taxes we all pay for Medicare’s health care. [4] (See this previous post for more detail on the Medicare Advantage rip off.)

Another example is Connecticut’s largest water system, which serves over 200,000 homes and businesses, and is privately owned by Eversource, the large New England utility corporation. It’s asking for a 42% rate increase ($88 million a year) or to allow it to be sold for $2.4 billion to a nonprofit, quasi-public entity. Many experts believe such a sale would lead to higher costs for consumers and weaker regulation. [5] This highlights the complexity and risk of having a public good such as water in private hands.

My next post will discuss the premiumization of markets, meaning that products and prices target consumers with high incomes, and factors that are keeping wages low.

[1]      Curry Wimbish, W., 12/5/25, “Meet the connectors,” The American Prospect (https://prospect.org/2025/12/05/meet-the-connectors-middlemen/)

[2]      Curry Wimbish, W., 12/5/25, see above

[3]      Dayen, D., 4/30/24, “Live Nation strikes up the band in Washington,” The American Prospect (https://prospect.org/2024/04/30/2024-04-30-live-nation-strikes-up-band-washington/)

[4]      Johnson, J., 1/28/26, “A $1.2 trillion ‘rip off’: Report spotlights massive scale of Medicare Advantage fraud,” Common Dreams (https://www.commondreams.org/news/medicare-advantage-fraud)

[5]      Associated Press, 12/18/25, “Connecticut’s largest water company seeking 42% rate increase,” The Boston Globe, Business Talking Points