The Exploitation Playbook: A Rent-Seeker

Despite being the most heavily regulated industry in the United States, our healthcare system is among the most expensive, inefficient, and inequitable in the world. Why haven't regulations produced a saner system?

This course argues that a major contributor to healthcare's dysfunction is rent-seeking behavior, in which powerful organizations use regulation to protect their interests and extract economic value. Well-intended regulations put in place to expand access, control costs, and protect patients are often subverted to create profit pools for industry incumbents and middlemen. The Exploitation Playbook is a tongue-in-cheek name for the course’s own organizing framework to help us understand how regulation gets captured, compromised, and ultimately converted into a tool of extraction by the very actors it was designed to constrain. Students learn to read healthcare regulation as a contested economic product shaped at every stage by actors with financial interests in its outcome.

The course investigates who writes the rules, who rewrites them during implementation, who defangs them during enforcement, and who builds billion-dollar businesses in the gaps that remain. The seminar then addresses harder questions: Given what we know about how regulation gets exploited, how do we design policy that is worth passing? How do we defend it against the actors who will immediately begin working to subvert it?

Through case analysis, framework application, and a policy proposal that will be developed each week of the course, students develop the analytical tools to anticipate how new regulations could be exploited and approaches to construct policies that will be resistant to those vulnerabilities. Graduates will be equipped to enter any healthcare policy environment—government, industry, advocacy, or academia—and immediately identify whose interests a proposed regulation serves, where its vulnerabilities lie, and what it would take to make it durable.