1.) Do NOT imply that individuals on the forum are in favor of murder.
There are a lot of people on the internet who are not always their best selves. Sometimes people experience bouts of illness where they get pretty psychotic. They might be really good people. But a certain proportion of the population experiences periods of time when they aren’t as able to clearly process what they read.
The internet is REALLY scary for people when they can’t process info well. The whole world is scary when your brain isn’t functioning the way that it is supposed to. We know that as diabetics.
We can’t not talk about policy that took diabetics 20 years to pass. Here is the first mention of a diabetic discussing PBMs on this forum. New Healthcare Plans and Our Dysfunctional Medical System ... Urgh! It’s from 2008. Healthcare has too much impact on us to not be able to discuss it. But we can’t create posts that put one another at risk by using the “m” word, or implying that diabetics like “m”. That is a way of creating actual, real world risk. Resist the urge. Maybe, instead, we quote what they wrote and write, “That offends me.” I dunno. Maybe we could have code words, like instead of “murder,” write “mutton.” I dunno. Maybe instead of “shooter,” we write “shutton.”
No one has yet been able to figure how to conduct this policy conversation. We can. I know it. I’m not 100% certain HOW, but we can do it without writing things that put one another at risk. Your my team. Help me do this correctly. It’s tricky. That’s why no one is writing anything…not even the press.
We had a bunch of guys in Minneapolis involved in a bunch of Federal crimes down at UHG. We all know that here. That’s not super surprising to me. It used to be called, “Muttonapolis,” in the 80s. It’s also not super surprising to me that when your involved in a bunch of federal crimes, bad things occasionally happen to you. I don’t think that should prevent us from talking about policy, but lets do it conscientiously, I guess. I don’t think anything that I have written here, warrants anyone implying directly on the internet that I am pro-mutton. Let’s watch that stuff.
What is important about this, is that people across multiple industries (and the Federal Trade Commission agrees with them) have identified PBMs as the primary source of monopoly behavior in drug distribution.
I’m gonna explain some of the political background, so brace yourself…
We have other monopoly behavior popping up all over healthcare. For instance, large hospital mergers. The current FTC commissioner explains that once monopolies develop, the damage is done. It becomes a horrible problem to fix because they drive any competing hospitals out of biz. She says that she doesn’t have anywhere near the resources to deal with this stuff. It’s happening all over the country. She thinks that the best use of her available resources is to locate the largest hospital mergers and stop them BEFORE they occur. If they have already occurred, then she is wiping her hands of it.
10 years ago, when people on Tu explained these PBM problems to me, they said “You will never fix these problems because we lack antitrust laws in the US.” So that was a big problem. I was young & naive & ridiculously optimistic then, so I just brushed that off for the time being. Now, that has been a REALLY bad problem over the years when diabetics have gone in to sue the drug manufacturers over insulin costs. Most of that litigation has failed in State courts. Its very expensive for States to sue the drug manufacturers, so they take huge risks when they do this and the drug companies sue them whenever they try to pass laws. The States aren’t actually powerful enough to win against the drug manufacturers. That’s why we see the Feds involved now.
We saw many, many States working together like a pack of dogs ,over many years, trying to break the monopoly. They have tried all kinds of different, crazy strategies. They can’t do it.
Here’s where it gets more political…
Biden appointed Lina Khan as FTC commissioner. She’s a bright young thing out of the ivy leagues who specializes in monopolies. She has brought a LOT of antitrust lawsuits in the US, including Amazon, chicken farming industry, and the PBMs. This is her talking about all that: FTC Chair Lina Khan on Antitrust in the age of Amazon : NPR One
You will see BOTH Republican and Democrat support for Khan’s work. For example, they call Vance a “Khanservative,” because he likes her work. But, this stuff is complicated and there’s a lot of money that moves around. Its always been a little harder to sell “monopoly busting,” to the GOP at a Federal level. Part of that is because the partisans (who don’t typically get involved in policy and who don’t understand the nitty gritty details because NO ONE DOES - its too complicated), will say, “We support free markets, unhindered by Government regulation.” Because Khan was appointed by a DFL president, the job of the GOPs partisans is to separate/differentiate themselves from what the other party is doing. That’s just how partisan politics works.
Fundamentally, there was a cancer Doc down at the Mayo Clinic and when he started explaining the problems in the market to people in Minnesota (who brought the first State lawsuit against the insulin manufacturers and the first legislation to regulate the PBMs), he said that the diabetics and insulin were the best way to prove market fixing in drug distribution because we had the most data regarding that. He actually is motivated by cancer drug costs, but he needs the diabetics to prove this in court at a Federal level before he can work on his drug pricing.
Now, remember how nervous some people started getting when the administration changed around election time? That is, in part, because when the administration changes, the FTC commissioner changes. Why should we not worry about it? Because people have been working on this for 20 years and administrations change during that time period. To make good policy, ideas have to survive both parties. That’s the nature of how the system validates itself. Its all part of the process. GOP is signaling that everything is gonna be OK. Trump mentioned the PBMs twice this week in public press conferences, but he calls the “middlemen”.
Why might it be important to talk about this now?
1.) The work is in the hands of the President of the United States & the FTC, so it is irreversible now, and we can speak very freely;
2.) Because barley anyone understands what is happening outside of the diabetics, the small biz pharmacists, State governments, and the occasional Doc.
The “shutton” might or might not have understood that work on this was in progress. Now maybe everyone ought to know that we have work in the pipeline in order to prevent “mutton,” and to facilitate the national conversation that is taking place.
3.) The diabetics have a lot at stake and we don’t exactly know what’s gonna happen when the monopolies get busted up (but we can be fairly certain, now, that this is happening). Its gonna be painful to break the monopolies because the monopolies already exist.
We got stomped out again, but we will get them next time.
I think I have seen this kid (the reporter) hovering around my social media. I think he speaks really well on the topic. He has done his research and he has been out speaking with people. He’s in Madison, WI, so he knows local Minneapolis business.
Part of what he is getting at is that this whole issue speaks to the heart of integrity in our democratic institutions and if people believe that they can receive representation when they are up against large companies and large money. I think we can, but a lot of people disagree with me. I’ll give them this - everything takes a lot more time and effort for everyday people who are not professional lobbyists backed by infinite amounts of money.
I think it serves us well to communicate with Doctors, pharmacists, and other patient advocacy communities right now. The diabetics will be back this coming session to help the pharmacists sort this ■■■■ out. We ought to all try to play as one orchestra around the obstacles. We are very close to victory.
Near as I can tell, the basic function of the PBM was legislative. Once the legislators were assured there was a way for the donor class to siphon gigantic amounts of cash out of the system, they were all for it. It provides for a way to disguise responsibility for escalating costs, where each of the three entities—Pharmaceutical makers, Insurers, and PBMs themselves—can blame the others when questions are raised. A kind of 3-card monte. The “M” should really stand for “Middleman,” referring to the fact they play no useful role except for enabling and overseeing (“managing”) this skimming operation. The “Benefit” is the one enjoyed by the ones raking in the cash, not the patients. It’s all pretty bald, as indicated by the fact that when this set up was challenged a few years back, the main objection to eliminating the PBM layer was how many people would be laid off, not the loss of any useful function that needed fulfilling.
Complexity is their best friend. Explaining what a PBM is, is my own personal hell.
We continue building complexity, on top of complexity, atop corruption. The more we do that, the more people are involved in taking graft. The more people we employ to accept paychecks as a result of “financial fraud/financial engineering”, the less incentive there is to bust up a monopoly and the less integrity our American markets have. It creates incentive for Americans to not use their natural ingenuity to create real value in the economy because its just so much easier and more profitable to accept graft.
Somehow it all falls on diabetics to move the Federal Government. To that, I say, “it figures.” Diabetics have to do everything. We had to build our own medical device software to make up for industry failure. I’m gonna run one of you all for President and when we come to power, things will be different.
Just noting that the provision to make PBMs more transparent was stripped from the revised budget bill that just passed, at the behest of a private citizen with no electoral status whatsoever.
What if Congress and the FTC reach different conclusions? Is Congress just a strategy incase FTC looses in court? Which strategy is better? Is one faster than the other? Is one strategy more thorough?
Typically, if the Federal Trade Commission (FTC) tells a company (say, Lockheed Martin) they are concerned about monopolistic behavior and that they will take them to court, the company just rolls over and stops the behavior. That’s not what we see in this case with the PBMs. The PBMs are throwing everything at the Federal government. https://www.healthaffairs.org/content/forefront/pbms-challenge-ftc-enforcement-authority-federal-court FTC isn’t suing them in Federal court…in front of Federal judges. They are doing something a little softer. It’s an “administrative case.” Top Three Pharmacy Benefit Managers Will Face FTC In Joint Trial For Insulin Rebate Cases - Healthcare - United States. In order to do that, FTC sends each PBM a letter. In that letter, they demand information from the company so that they can assess if something illegal is going on. The PBMs simply refused to respond to the letter. Now, the FTC can throw them in jail for that. We see CVS and UHG behaving in a way that is obstructing federal process. Its a highly unusual strategy, but we have seen them do this to the States. They have got a lot of gall. This is them being them.
One problem for FTC that we see emerging is that UHG and CVS are just simply not going to comply with federal regulators and legal process. That’s an unusual problem that doesn’t usually pop up. Its POSSIBLE that when the Fed went asking for records, they simply were not supplied. It’s going to make everything in the process go extra slow and drag out for years. If the feds don’t have adequate data yet, then it could be problematic. But rest assured that eventually the federal government will just start throwing people in jail. This is not an effective long term strategy.
Let’s watch that stuff.
