Antitrust as a Guardrail for Socially Responsible Neurotechnology Design.

The neurotechnology sector is likely to develop under pressure towards commercialized, nonmedical products and may also undergo market consolidation. This possibility raises ethical, social, and policy concerns about the future responsibility of neurotechnology innovators and companies for high-consequence design decisions. Present-day internet technology firms furnish an instructive example of the problems that arise when providers of communicative technologies become too big for accountability. As a guardrail against the emergence of similar problems, concerned neurotechnologists may wish to draw inspiration from antitrust law and direct efforts, where appropriate, against undue consolidation in the commercial neurotechnology market.

The Economics of Scientific Publishing.

The peculiar nature of scientific publishing has allowed for a high degree of market concentration and a non-collusive oligopoly. The non-substitutable characteristic of scientific journals has facilitated an environment of market concentration. Acquisition of journals on a capabilities-based approach has seen market concentration increase in favor of a small group of dominant publishers. The digital era of scientific publishing has accelerated concentration. Competition laws have failed to prevent anti-competitive practices. The need for government intervention is debated. The definition of scientific publishing as a public good is evaluated to determine the need for intervention. Policy implications are suggested to increase competitiveness in the short-run and present prestige-maintaining alternatives in the long run. A fundamental change in scientific publishing is required to enable socially efficient and equitable access for wider society's benefit.

Research Diversity and Invention.

This paper explains that when there is great uncertainty about which elements of knowledge must be combined to make an invention, the likelihood of invention increases markedly-by many orders of magnitude-when there are numerous diverse research organizations, rather than just a few. The paper examines the possibility that competition (antitrust) policy toward mergers would be improved if enforcement efforts placed more emphasis on protecting the diversity that is provided by numerous research rivals in a market.

Straight Teeth and Misaligned Interests: Courtrooms Are Crowded with SmileDirectClub Litigation.

SmileDirectClub markets, manufactures, and delivers clear plastic dental aligners directly to the consumer: no dental office necessary. This well-known business strategy-cut costs by cutting out the middleman-has in several instances caught the attention of state dental regulators. While the dental boards consider some of SmileDirectClub's practices to be violative of state dental practice law, the corporation has fought back in federal court, charging dental regulators with antitrust violations and with denying SmileDirectClub its constitutional rights.The Supreme Court, as noted by SmileDirectClub, has insisted that a self-regulating state professional board is not itself the state, so a board's actions might be subject to federal antitrust law. In the SmileDirectClub cases, however, state regulators have acted as required by state legislatures and as expressed in state dental practice acts. The boards' activities here are therefore cloaked in the states' immunity to antitrust litigation and should be treated deferentially by federal courts. Furthermore, judicial review of the substance of every regulation to which SmileDirectClub objects is inappropriate under principles of constitutional law. In the interest of public safety, courts should permit state dental regulators to fulfill their mandates and ensure that all dental providers comply with state health regulations.

Recent Developments at DG Competition: 2021/2022.

The Directorate General for Competition at the European Commission enforces competition law in the areas of antitrust, merger control, and State aid. After providing a general presentation of the role of the Chief Competition Economist's team, this article surveys some of the main developments at the Directorate General for Competition over 2021/2022. In particular, the article reviews the new antitrust "Vertical Block Exemption Regulation" and "Vertical Guidelines", the new "Guidelines on State aid for climate, environmental protection, and energy", and the Veolia/Suez merger.

Integrating Africa by Competition and Market Policy.

Africa has the African Continental Free Trade Area (AfCFTA). The agreement will lower tariffs and facilitate internal market trade on the continent, and policy makers hope that it will help lift 30 million people out of poverty. A competition protocol is now in the process of negotiation and proposals have been made ranging from a full, detailed, technical competition law as in the West to a scaffolding of regional cooperation. For the competition element of AfCFTA, this article makes a bold suggestion: Africa needs a basic but deep competition protocol, which concentrates on the priorities "at the top": It needs to rid the continent of insidious trade-and-competition restraints at member state borders that prevent African integration, which requires a joinder of trade-and-competition violations. And it needs a voice at the top to take a stand for the continent: for example against the mega-mergers that hurt Africa. Only with these three elements-clear basic rules, trade/competition restraint prohibitions, and a voice at the top-can Africa hope to realize the promise of Africa.

The influence of corporate market power on health: exploring the structure-conduct-performance model from a public health perspective.

BACKGROUND: The detrimental impact of dominant corporations active in health-harming commodity industries is well recognised. However, to date, existing analyses of the ways in which corporations influence health have paid limited attention to corporate market power. Accordingly, the public health implications of concentrated market structures, the use of anti-competitive market strategies, and the ways in which market power mediates the allocation and distribution of resources via market systems, remain relatively unexplored. To address this gap, this paper aimed to identify and explore key literature that could inform a comprehensive framework to examine corporate market power from a public health perspective. The ultra-processed food (UPF) industry was used to provide illustrative examples. METHODS: A scoping review of a diverse range of literature, including Industrial Organization, welfare economics, global political economy and antitrust policy, was conducted to identify important concepts and metrics that could be drawn upon within the field of public health to understand and explore market power. The Structure-Conduct-Performance (SCP) model, a guiding principle of antitrust policy and the regulation of market power, was used as an organising framework. RESULTS: We described each of the components of the traditional SCP model and how they have historically been used to assess market power through examining the interrelations between the structure of industries and markets, the conduct of dominant firms, and the overall ability of markets and firms to efficiently allocate and distribute the scarce resources. CONCLUSION: We argue that the SCP model is well-placed to broaden public health research into the ways in which corporations influence health. In addition, the development of a comprehensive framework based on the key findings of this paper could help the public health community to better engage with a set of policy and regulatory tools that have the potential to curb the concentration of corporate power for the betterment of population health.

The 2010 HMGs Ten Years Later: Where Do We Go From Here?

In this article, which is part of the Symposium on the Tenth Anniversary of the 2010 Horizontal Merger Guidelines, we suggest a number of improvements that should be considered in the next revision of the Guidelines. Our analysis is based on the observation that horizontal merger policy has suffered from under-enforcement. We provide evidence that the enforcement agencies face significant resource constraints that require a triage process that inevitably leads to under-enforcement. In light of merger law placing greater weight on avoiding false negatives and under-deterrence than false positive and over-deterrence, the article suggests a number of ways in which the under-enforcement bias might be corrected, including (among others): rolling back the increase in the HHI "red zone" thresholds; mandating anticompetitive presumptions for mergers with high GUPPIs, acquisitions of mavericks, and acquisitions by dominant firms; closer analysis of common ownership by financial funds; and expanded analysis of potential competition mergers.

Recent Developments at DG Competition: 2020/2021.

The Directorate General for Competition at the European Commission enforces competition law in the areas of antitrust, merger control, and State aid. After providing a general presentation of the role of the Chief Competition Economist's team, this article surveys some of the main developments at the Directorate General for Competition over 2020/2021. In particular, the article discusses the Commission proposal on the Digital Markets Act, the developments on the State aid response related to the COVID pandemic as well as the Danfoss/Eaton merger.

Price Transparency: Empowering Patient Choice and Promoting Provider Competition.

In light of recent health policy efforts to promote price transparency, this perspective reviews the challenges and benefits of price transparency. These price transparency efforts include the recent executive order and associated rulemaking directing providers to disclose negotiated and out-of-pocket costs for "shoppable" healthcare services. First, we explore the previous efforts of states and health plans targeted at price transparency, reviewing lessons for future implementation. Second, we address the value of price transparency in light of various policy concerns and objections. Finally, we jointly hypothesize potential effects of and opportunities presented by price transparency for patients, physicians, and other healthcare industry stakeholders.

Recent Developments at DG Competition: 2019/2020.

The Directorate General for Competition at the European Commission enforces competition law in the areas of antitrust, merger control, and State aid. After providing a general presentation of the role of the Chief Competition Economist's team, this article surveys some of the main developments at the Directorate General for Competition over 2019/2020. In particular, the article reviews the economic analysis in the Qualcomm predation case, recent developments in the assessment of vertical mergers, as well as the new "Temporary Framework" that has been developed in the wake of the COVID pandemic.

Geographic Market Definition in the Merger Guidelines: A Retrospective Analysis.

Since the initial Merger Guidelines in 1968, the Department of Justice and Federal Trade Commission have revised their merger enforcement screen over the course of six versions. This article examines the evolution of the geographic market component of the Guidelines and the economic implications of changing standards of market delineation on merger enforcement. Using an illustration from the beer industry, we chronicle the development of geographic market definition and its varying effects on merger enforcement over the past 50 years.

Recent Developments at DG Competition: 2017/2018.

The Directorate General for Competition at the European Commission enforces competition law in the areas of antitrust, merger control, and state aids. This year's article provides first a general presentation of the role of the Chief Competition Economist's team and surveys some of the main achievements of the Directorate General for Competition over 2017/2018. The article then reviews: the Google Search (Shopping) case, the role of price discrimination in state aid cases; and the use of counterfactuals in merger cases where alternative transactions might have occurred absent the merger.

Recent Developments at DG Competition: 2016/2017.

The Directorate General for Competition at the European Commission enforces competition law in the areas of antitrust, merger control, and state aids. This year's article provides first a general presentation of the role of the Chief Competition Economist's team and surveys the main achievements of the Directorate General for Competition over 2016/2017. The article then reviews the economic work undertaken in one merger case between Dow/DuPont, which raised specific issues related to innovation, as well as in an antitrust case on parity clauses related to Amazon e-books.

Antitrust and Provider Collaborations: Where We've Been and What Should Be Done Now.

Antitrust enforcement has a crucial role to play in consolidated health care markets as providers undertake mergers, acquisitions, and other types of collaborations to integrate care and achieve greater size and scale. But antitrust enforcers and policy makers need to refine their approach in two fundamental ways. First, in addition to focusing on whether particular transactions or conduct will increase prices above competitive levels, a more pressing concern should be on assuring that health care markets are conducive to fundamental changes in how care is reimbursed and delivered - that is, the impact on payment and health care delivery innovation. Second, it is important to recognize the practical limits that apply to antitrust enforcement, both in terms of existing law and precedent and the constrained resources available to government enforcers. Government resources can be leveraged substantially through greater collaboration among federal and state antitrust enforcers, government payers, health care regulators, and economists and other policy makers. This can result in not only better-targeted antitrust enforcement actions but also payment and regulatory initiatives that can produce better-functioning and more competitive health care markets.

A Few Thoughts about ACO Antitrust Issues from a Local Enforcement Perspective.

Accountable care organizations (ACOs), joint ventures of commercial insurers and various groups of medical providers such as physicians, specialists, and hospitals whose development in California has been quickened by the Affordable Care Act, carry with them both promise and pitfalls. On the positive side of the ledger, ACOs may improve the quality of medical care even as they lower the costs of that care. On the negative side of the ledger, ACOs may lead to a gain in market power for their participations, allowing those participants to increase the prices they charge to commercial insurers. It is thus a key question for antitrust enforcers to figure out how to separate the sheep from the goats. This article, representing our personal views as state antitrust enforcers in the California attorney general's office, offers our reflection on a number of ACO articles and studies in this special issue through the prism of this key question and sets out a number of additional issues that we believe warrant study in conjunction with ACOs.

Addressing Pricing Power in Integrated Delivery: The Limits of Antitrust.

Prices are the major driver of why the United States spends so much more on health care than other countries do. The pricing power that hospitals have garnered recently has resulted from consolidated delivery systems and concentrated markets, leading to enhanced negotiating leverage. But consolidation may be the wrong frame for viewing the problem of high and highly variable prices; many "must-have" hospitals achieve their pricing power from sources other than consolidation, for example, reputation. Further, the frame of consolidation leads to unrealistic expectations for what antitrust's role in addressing pricing power should be, especially because in the wake of two periods of merger "manias" and "frenzies" many markets already lack effective competition. It is particularly challenging for antitrust to address extant monopolies lawfully attained. New payment and delivery models being pioneered in Medicare, especially those built around accountable care organizations (ACOs), offer an opportunity to reduce pricing power, but only if they are implemented with a clear eye on the impact on prices in commercial insurance markets. This article proposes approaches that public and private payers should consider to complement the role of antitrust to assure that ACOs will actually help control costs in commercial markets as well as in Medicare and Medicaid.

Encouraging Competition and Cooperation: The Affordable Care Act's Contradiction?

This introductory essay to JHPPL's special issue on accountable care organizations (ACOs) presents the broader themes addressed in the issue, including (1) a central tension between cooperation versus competition in health care markets with regard to how to bring about improved quality, lower costs, and better access; (2) US regulatory policy - whether it will be able to achieve the appropriate balance in health care markets under which ACOs could realize expected outcomes; and (3) ACO realities - whether ACOs will be able to overcome or further embed existing inequities in US health care markets.

Accountable Care Organizations and Antitrust Enforcement: Promoting Competition and Innovation.

The antitrust laws stand to protect consumers of health care services from conduct that would raise prices, lower quality, and decrease innovation by lessening competition. Importantly, though, vigorous antitrust enforcement does not impede accountable care organizations (ACOs) and similar collaborations that advance these same goals of better and more efficient care; in fact, by fostering competitive markets, the antitrust laws encourage such initiatives. This article summarizes the legal framework that the federal antitrust agencies - the Federal Trade Commission and the Antitrust Division of the US Department of Justice - use to analyze ACOs and other collaborations among health care providers. It outlines the guidance provided by the federal antitrust agencies concerning when ACOs and other provider collaborations likely would harm competition and consumers. In addition, it reviews common antitrust issues that can arise with ACOs and provides examples of enforcement actions that have prevented health care providers from taking or continuing anticompetitive actions.

Can antitrust policy promote enterprise innovation? Evidence from Zhongguancun science and Technology Park.

Emerging countries usually rely on the innovation of enterprises within the regional innovation ecosystem to enhance the national innovation level. However, existing literature lacks insight into how antitrust policies might influence innovation within them. We estimate the impact of the implementation of the Anti-Monopoly Law on enterprise innovation within Zhongguancun Science and Technology Park, China's prominentregional innovation ecosystem. Using a cross-industry difference-in-difference design, we show that greater exposure to competition shock materially boosted enterprise innovation. Antitrust policy promotes enterprise innovation by increasing the R&D investment, human capital, and export. The promotion effect of antitrust is relatively strong in the sample of electronic information industry, firms with low levels of financing constraints, and those that undertake open innovation. Our findings elucidate the nexus between competition and innovation in regional innovation ecosystems and underscore the pivotal role of antitrust policies in the development of Zhongguancun Science and Technology Park.