THE AFFORDABILITY CRISIS Part 3
The affordability crisis in the U.S. is multifaceted and has been growing for 45 years, due to low pay and high prices. Many factors are pushing up prices well beyond normal inflation, including premiumization of markets, profit-taking middlemen, and the failure to enforce antitrust laws. The Trump administration is doing nothing that affectively addresses the affordability crisis, while many of its actions exacerbate it.
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My last post discussed profit-taking by middlemen and privatization of public goods and services as drivers of high prices. The previous post presented an overview of the affordability crisis in the U.S., its 45 year history, and discussed monopolistic price gouging, tariffs, and personalized (aka surveillance) pricing as factors leading to high prices.
This post will discuss:
· The premiumization of markets, meaning that products and prices target consumers with high incomes.
· Efforts to reduce pharmacy benefit managers’ (PBMs) inflation of drug prices.
· The failure of the Trump administration to enforce antitrust laws, which allows unjustifiable increase prices by Live Nation / Ticketmaster and others.
The so-called premiumization of markets is happening because high economic inequality leads to consumer spending patterns that make things more expensive for everyone. Consumer spending represents roughly 70% of all economic activity in the U.S. and therefore drives the economy. However, given the high levels of economic inequality, the wealthiest 10% of Americans are now doing almost half of all consumer spending. As a result, retailers target their products and prices to those high-income consumers. Products often become more upscale and their prices go up. Lower priced options tend to disappear, or their prices go up because key consumers can afford to pay more. Sometimes the higher prices are “justified” by adding frills or fancier packaging. Sometimes those with money bid up the price of goods or services with a limited supply, such as housing, raising prices for everyone.
Moreover, the middle class, striving for upward mobility (or at least the appearance of it) and to “keep up with the Joneses,” feels coerced into spending like the top 10%. Fancy clothes and cars, expensive parties and weddings, and so forth are what some feel they need to buy to maintain their status with peers. Easy access to debt, including buy now, pay later (BNPL) plans, facilitate living beyond one’s means. For example, a quarter of BNPL consumers have used BNPL to pay their rent, a third have used it to pay for medical or dental expenses, and nearly 40% have used it to pay off another debt, such as a credit card. [1]
One example of premiumization is the market for workout gyms and health clubs. The market is bifurcating in many locations and the middle-priced facilities are disappearing. The remaining options are the bare bones gym at $15 to $50 a month, which is often quite crowded at peak times, and the upper-end health clubs at over $200 a month, featuring plush locker rooms, personal trainers, and sometimes jacuzzies, saunas, and a spa. [2]
Pharmacy Benefit Managers (PBMs) were supposed to reduce drug costs, saving insurers and consumers money, but they have morphed into rapacious profit makers. (See this previous post for more details.) Three huge, monopolistic PBMs (Cigna’s Express Scripts, CVS Health’s Caremark, and United Health’s Optum RX) manage 80% of the prescription drug business in the U.S. It’s estimated that 42 cents of every dollar paid for prescription drugs now goes to a PBM. [3] The spending bill passed by Congress in early February includes an effort to rein in PBMs and reduce drug prices. Starting in 2028, PBMs will be paid a flat fee rather than a percentage of a drug’s price, which will eliminate the incentive to push high-priced drugs even when cheaper alternatives are available. Increased disclosure by PBMs will be required and kickbacks from drug manufacturers will have to be passed back to the PBMs’ customers. [4]
As with the PBMs, other monopolistic middlemen can manipulate the market to make unjustifiably large profits. As this previous post highlighted, Live Nation (parent company of Ticket Master) is a prime example of a monopolistic middleman. [5] It handles the ticket sales for over 80% of the country’s prime concert venues, owns or controls over 330 venues, and manages over 400 top-of-the-line artists. However, the Trump Department of Justice (DOJ) appears to be about to agree to a lenient settlement of the antitrust case against Live Nation. This is happening despite Trump’s executive order in 2025 supposedly cracking down on price gouging for event tickets. And even though 40 state Attorneys General are also parties to the suit against Live Nation / Ticketmaster. Some of them are likely to continue the suit, but the federal settlement will make it harder. By the way, the Federal Trade Commission also sued Live Nation last September for deceptive ticket pricing. [6]
Trump-connected lobbyists have apparently overpowered the DOJ’s own antitrust division and gotten Trump and Attorney General Bondi to overrule the antitrust division once again. As a result, the head of the antitrust division, Gail Slater, resigned a few days after her second in command, Mark Hamer, had resigned. Back in August, the previous number two person, Roger Alford, was fired for resisting sweetheart settlements of antitrust cases. Trump friend, Mike Davis, is the lobbyist for Live Nation and he had previously gotten a $1 million “success fee” for getting the DOJ to drop its challenge to Hewlett Packard’s merger with Juniper Networks. (Several state Attorneys General are challenging the approval of this merger.) He also earned at least $1 million for getting the DOJ to approve the merger of the country’s two largest real estate brokers, Compass and Anywhere Real Estate, over the objections of antitrust division lawyers. Senator Elizabeth Warren (D-MA) said the settlements of these antitrust cases “looks like corruption. … MAGA-aligned lawyers and lobbyists have been trying to sell off merger approvals … to the highest bidder.” [7]
The Trump administration’s failure to enforce antitrust laws allows monopolistic companies to increase prices, overwhelm small businesses, and put a damper on innovation. Overall, the Trump administration is doing nothing that affectively addresses the affordability crisis, while many of its actions exacerbate it.
My next post will discuss the income side of the affordability crisis and the factors that lead to low pay.
[1] Janssen, E., 12/1/25, “Selling the poor on spending like they’re rich,” The American Prospect (https://prospect.org/2025/12/01/premiumization-plutonomy-middle-class-spending-gilded-age/)
[2] Fonseca, C., & Hecht, B., 2/13/26, “Slimmer pickings on midrange gym options,” The Boston Globe
[3] Curry Wimbish, W., 12/5/25, “Meet the connectors,” The American Prospect (https://prospect.org/2025/12/05/meet-the-connectors-middlemen/)
[4] Abelson, R., & Robbins, R., 2/5/26, “Congress looks to diagnose cause of high drug prices,” The Boston Globe from The New York Times
[5] 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/)
[6] Dayen, D., 2/12/26, “Trump Justice Department poised to preserve Ticketmaster monopoly,” The American Prospect (https://prospect.org/2026/02/12/trump-justice-department-ticketmaster-live-nation-monopoly/)
[7] Johnson, J., 2/13/26, “Warren says Trump DOJ ouster of antitrust chief ‘looks like corruption’ as lobbyists, Wall St rejoice,” Common Dreams (https://www.commondreams.org/news/warren-gail-slater-antitrust)