PBMs generate revenue from multiple sources simultaneously, allowing profits to shift from one channel to another whenever reforms target a single practice.
100%. Only problem with Lessig is his naivety in believing that SCOTUS can be reasoned with or that by demonstrating the extent of its logical/factual fallacies in a future case (as if it would even grant cert to such a case), the justices would be forced to reverse course. I would like to remind Lessig that “Reasoning will never make a Man correct an ill Opinion, which by Reasoning he never acquired”.
I'd be interested in where you see that naivety? Maybe earlier in his writing?
More recently he's been openly critical - and I don't think he sees reasoning alone as any kind of resolution to this court's illegitimacy.
"The Supreme Court has entered yet another stage of illegitimacy. It’s happened before. One might have hoped it would not happen again. But it has. The Court has become an activist, democratically untethered institution, remaking broad swaths of constitutional and statutory law, without any constitutional or democratic justification." (June, 2024)
"When the facts change, I change my mind. What do you do, sir?"
“I don't believe the Court is a partisan institution. I instead believe that it has simply not yet worked out what a consistent position for its newfound originalist majority should be. And when it finally gets around to considering that question in the context of campaign finance, it will recognize its inconsistency. The question then will be what it will do.”
the integrity of our entire system of government should not and cannot be left up to five individuals. we the people must be the ones to decide what corruption is- and all the data shows the overwhelming majority of Americans believe that bribing lawmakers should not be legal, while SCOTUS keeps issuing one pro-corruption ruling after another.
Fair point - but I also think he's being potentially more nuanced by separating the "institution" from corrupt indiviudals - even if that's a majority - b/c they aren't ALL corrupt.
As a retired pharmacist I pretty much understand all of the five revenue streams you have described and I appreciate your explanation of what is going on in the whack-a-mole PBM pricing scams. I am reminded of an analogy put forward by another writer in this substack. He said the verticly integrated monopolies of insurance companies, PBMs, pharmacies, doctors are similar to a for profit fire department run by arsonists. I would add that I would not try to reform the arsonists. I'd get rid of them. So it is with these utterly corrupt PBMs. If you "reform" these five streams of cash flowing into PBMs, they will come up with a sixth. Both PBMs and for profit insurance companies have got to go.
The monopolistic healthcare industry is operating a Ponzi scheme because they reap all the benefits while the insured get horrible coverage and pay obnoxious premiums for it.
I have lived experience stories about PBMs going back two decades. They are a scourge on healthcare, more so than any other part of the hub and spoke. They should be gone.
If seasoned healthcare professionals and policy experts like us have difficulty understanding this multi-tentacled shell game, there’s a fart’s chance in a hurricane that the fuckwits running our country can wrap their pea-brains around it.
don’t be intimidated or doubt yourself. it is just a lot of bs/fraud comparable to the “complex financial derivatives” schemes of the Great Recession. a bunch of financial engineering bs that sounds complicated but would be considered fraud in any other country.
There's actually a 6th reform that needs to happen - without which the other 5 will never happen.
"Campaign finance reform isn't the biggest problem facing the country - but it's the first." Lawrence Lessig
The system we have is working exactly as designed - and the complexity (like the pharma roulette referenced here) is a feature - not a bug.
Bingo!
🎯
100%. Only problem with Lessig is his naivety in believing that SCOTUS can be reasoned with or that by demonstrating the extent of its logical/factual fallacies in a future case (as if it would even grant cert to such a case), the justices would be forced to reverse course. I would like to remind Lessig that “Reasoning will never make a Man correct an ill Opinion, which by Reasoning he never acquired”.
I'd be interested in where you see that naivety? Maybe earlier in his writing?
More recently he's been openly critical - and I don't think he sees reasoning alone as any kind of resolution to this court's illegitimacy.
"The Supreme Court has entered yet another stage of illegitimacy. It’s happened before. One might have hoped it would not happen again. But it has. The Court has become an activist, democratically untethered institution, remaking broad swaths of constitutional and statutory law, without any constitutional or democratic justification." (June, 2024)
"When the facts change, I change my mind. What do you do, sir?"
from an article he wrote two days ago on medium:
“I don't believe the Court is a partisan institution. I instead believe that it has simply not yet worked out what a consistent position for its newfound originalist majority should be. And when it finally gets around to considering that question in the context of campaign finance, it will recognize its inconsistency. The question then will be what it will do.”
the integrity of our entire system of government should not and cannot be left up to five individuals. we the people must be the ones to decide what corruption is- and all the data shows the overwhelming majority of Americans believe that bribing lawmakers should not be legal, while SCOTUS keeps issuing one pro-corruption ruling after another.
Fair point - but I also think he's being potentially more nuanced by separating the "institution" from corrupt indiviudals - even if that's a majority - b/c they aren't ALL corrupt.
As a retired pharmacist I pretty much understand all of the five revenue streams you have described and I appreciate your explanation of what is going on in the whack-a-mole PBM pricing scams. I am reminded of an analogy put forward by another writer in this substack. He said the verticly integrated monopolies of insurance companies, PBMs, pharmacies, doctors are similar to a for profit fire department run by arsonists. I would add that I would not try to reform the arsonists. I'd get rid of them. So it is with these utterly corrupt PBMs. If you "reform" these five streams of cash flowing into PBMs, they will come up with a sixth. Both PBMs and for profit insurance companies have got to go.
I love this degree of granularity. Do more!
I’ll look forward to further details on the GPO/PBM scam with its ever shifting margins. Thank you
Have y’all noticed all the fraud waste and abuse in American health care is in corporations?
Yet the regime cut medical programs instead of regulating a rogue industry
Corporations get more government hand outs than any individual will ever receive
So true
The monopolistic healthcare industry is operating a Ponzi scheme because they reap all the benefits while the insured get horrible coverage and pay obnoxious premiums for it.
Drug-profit scavengers!
I have lived experience stories about PBMs going back two decades. They are a scourge on healthcare, more so than any other part of the hub and spoke. They should be gone.
Now 90% of democratic voters support Medicare for ALL and 63% of ALL voters support Medicare for ALL
If seasoned healthcare professionals and policy experts like us have difficulty understanding this multi-tentacled shell game, there’s a fart’s chance in a hurricane that the fuckwits running our country can wrap their pea-brains around it.
I’m not dumb, but reading these articles about how broken our healthcare system is gives me a headache - it feels downright injurious to my health.
don’t be intimidated or doubt yourself. it is just a lot of bs/fraud comparable to the “complex financial derivatives” schemes of the Great Recession. a bunch of financial engineering bs that sounds complicated but would be considered fraud in any other country.
To be clear, I am not intimidated - just disgusted.