The American medical system is full of middle men between me and anyone who might care about me. Drug middle men, insurance companies, potentially ambulances, even the large medical groups that people who directly provide me care work for ... I have no idea who does what, what financial things are at play, and I feel like it changes so fast I couldn't possibly keep up.
Other than simply not ever getting medical care, I can't even choose to not do business with these groups who have zero vested interest in me being healthy but are more in-control of the care I get than I am.
Even the people who directly provide me care don't seem to know.
Everything is a moving black box that seems ripe for shenanigans.
salawat · 1d ago
As someone with experience I. The PBM world, they are the only actors in a position to do the "responsible" thing. The problem though, is spread. Which is the foundational profit taking mechanism of most PBM's. Their profit is the difference between the amount of money they estimate they'll need to cover the group, and what they actually pay out based on the gray area between their benefit schedule. That money is investable as float. This means that the higher drug prices are, the more money they have to manage. This, combined with things like pharmaceutical manufacturer rebates, disincents actual downward pressure on drug prices.
If you want to get to the bottom of problem of the medical supply chain in the U.S., crack open, investigate with a fine toothed comb, and regulate PBM's. Preferably sacking everyone working there who utters the phrase "we want to be responsible financial stewards by making sure it's harder for people to get the care they need".
Other than simply not ever getting medical care, I can't even choose to not do business with these groups who have zero vested interest in me being healthy but are more in-control of the care I get than I am.
Even the people who directly provide me care don't seem to know.
Everything is a moving black box that seems ripe for shenanigans.
If you want to get to the bottom of problem of the medical supply chain in the U.S., crack open, investigate with a fine toothed comb, and regulate PBM's. Preferably sacking everyone working there who utters the phrase "we want to be responsible financial stewards by making sure it's harder for people to get the care they need".