This is a real concern for me because people credit the ACA with making a big dent in the healthcare problem here in the US, but it feels more like it just created a massive legal protection for these exploitative middlemen when the necessary solution was to blow up the entire industry with a true public option that could out-compete every profit-driven money-extraction system by simply not being profit-driven.<p>Not every system becomes more efficient with profit incentives, and this really seems like just such a case.
The whole system is infuriating. Even when you assume a free market is what you want, it's pretty clear that this is far away from a free market. Unless you view non-competitive monopolies as free market.<p>I don't understand why vertical integration is not made illegal. An insurer should not own a PBM or providers. They all should have an adverse relationship so they put cost pressure on each other.<p>Also, providers should charge the same prices for the same procedures no matter who pays. Ideally everybody should be mandated to follow Medicare prices. If these prices are too low to survive, then there should be a discussion about adjusting the prices.<p>The whole system is basically a huge bureaucracy that wastes a lot of money but some of the waste is enough profit for a lot of people to fight tooth and nail to keep the status quo.
My dad used to have a job where he’d basically go around to failing small-time family practices and help the doctors there figure out their financials. I remember him telling me that in an extremely typical scenario, he’d walk into their office and somewhere in there he would find a huge stack of unfiled insurance claims.<p>Usually when he’d ask them about this, the process of filing these claims with the insurance companies was so onerous, they just fell way behind on the process. Typically you could resolve this by bringing in someone with a LOT of experience filing these claims I believe.<p>This was back in the 90s, so maybe the advent of computers has improved this particular part of the game (I’m not in the industry myself), but at least back then, it was infuriating doctors too.<p>I am not surprised in the least to hear that, like every other system in this economy, it seems to have gotten massively more complicated for approximately zero real-world improvement
One of the rare bipartisan areas of agreement in Congress right now is the need to rein in these Pharmacy Benefit Managers (PBMs). Both Republicans and Democrats had rallied around reforms to increase PBM transparency, which could lower costs for employers and, eventually, consumers.<p>But just as a major PBM reform bill was set to pass last December, Elon Musk fired off a series of tweets opposing it. Within hours, what had been near-unanimous support collapsed. Five days later, Musk tweeted, "What is a pharmacy benefit manager?"—as if he had only just learned about the issue.<p>This isn’t about whether Musk was right or wrong on PBMs (though evidence suggests reform would lower costs). The bigger issue is how a single billionaire’s influence can derail democratic processes that were functioning as intended. When a reform has broad bipartisan support, expert backing, and clear public benefits, yet can still be nuked by one well-placed tweet, that’s not just a policy failure—it’s a governance problem.<p>Tech billionaires reshaping policy via social media whims should concern anyone who cares about democratic accountability. If Musk can tank a bill that helps millions save on prescriptions, what else can be undone with a midnight tweetstorm?