And the reality is that getting universal COVERAGE is unrelated to PUBLIC debates around healthcare policy.
Majority of Americans (57% v 40%) say "it is the responsibility of the federal government to make sure all Americans have healthcare coverage."
That fact is ignored in D.C.
Majority of Americans (57% v 40%) say "it is the responsibility of the federal government to make sure all Americans have healthcare coverage."
That fact is ignored in D.C.
December 25, 2025 at 3:57 PM
And the reality is that getting universal COVERAGE is unrelated to PUBLIC debates around healthcare policy.
Majority of Americans (57% v 40%) say "it is the responsibility of the federal government to make sure all Americans have healthcare coverage."
That fact is ignored in D.C.
Majority of Americans (57% v 40%) say "it is the responsibility of the federal government to make sure all Americans have healthcare coverage."
That fact is ignored in D.C.
Canada is just one example ... and not that recent.
More recently - China went from ~50% coverage to near universal in about 6 years [2005 to 2011}.
NB: There is no PERFECT system - but our system of tiered coverage is what makes us an outlier.
More recently - China went from ~50% coverage to near universal in about 6 years [2005 to 2011}.
NB: There is no PERFECT system - but our system of tiered coverage is what makes us an outlier.
December 25, 2025 at 5:14 AM
Canada is just one example ... and not that recent.
More recently - China went from ~50% coverage to near universal in about 6 years [2005 to 2011}.
NB: There is no PERFECT system - but our system of tiered coverage is what makes us an outlier.
More recently - China went from ~50% coverage to near universal in about 6 years [2005 to 2011}.
NB: There is no PERFECT system - but our system of tiered coverage is what makes us an outlier.
Yup. Ideas are easy, but since systemic HC reform will require sweeping changes to the tax code - we're further away from it than we've ever been (and it's been a political debate since the 1940's).
What we're left with are tweaks around the edges - which doesn't do much [incl ACA].
What we're left with are tweaks around the edges - which doesn't do much [incl ACA].
December 25, 2025 at 5:08 AM
Yup. Ideas are easy, but since systemic HC reform will require sweeping changes to the tax code - we're further away from it than we've ever been (and it's been a political debate since the 1940's).
What we're left with are tweaks around the edges - which doesn't do much [incl ACA].
What we're left with are tweaks around the edges - which doesn't do much [incl ACA].
There's a lot he doesn't understand ...
... incl the fact that his @CostPlusDrugs isn't all sunshine and roses.
There are consequences to siphoning margin from generic mfg's ... namely shortages - but there are other negatives too.
... incl the fact that his @CostPlusDrugs isn't all sunshine and roses.
There are consequences to siphoning margin from generic mfg's ... namely shortages - but there are other negatives too.
December 12, 2025 at 5:46 AM
There's a lot he doesn't understand ...
... incl the fact that his @CostPlusDrugs isn't all sunshine and roses.
There are consequences to siphoning margin from generic mfg's ... namely shortages - but there are other negatives too.
... incl the fact that his @CostPlusDrugs isn't all sunshine and roses.
There are consequences to siphoning margin from generic mfg's ... namely shortages - but there are other negatives too.
Millions? Seriously? Still playing fantasy healthcare I see.
Pushing generics to rock-bottom cash prices is a stellar idea - right up until every mfg bails and you can’t find amoxicillin anywhere.
Pushing generics to rock-bottom cash prices is a stellar idea - right up until every mfg bails and you can’t find amoxicillin anywhere.
December 11, 2025 at 3:43 PM
Millions? Seriously? Still playing fantasy healthcare I see.
Pushing generics to rock-bottom cash prices is a stellar idea - right up until every mfg bails and you can’t find amoxicillin anywhere.
Pushing generics to rock-bottom cash prices is a stellar idea - right up until every mfg bails and you can’t find amoxicillin anywhere.
FWIW ... China expanded health coverage rapidly - from ~50 to ~95% - in about 6 years (2005 to 2011).
Saying that UHC is only achievable in some archive of history isn't accurate.
Footnote: M4A moves the convo forward - but isn't workable as outlined so far b/c it truncated debate on price.
Saying that UHC is only achievable in some archive of history isn't accurate.
Footnote: M4A moves the convo forward - but isn't workable as outlined so far b/c it truncated debate on price.
December 11, 2025 at 1:21 AM
FWIW ... China expanded health coverage rapidly - from ~50 to ~95% - in about 6 years (2005 to 2011).
Saying that UHC is only achievable in some archive of history isn't accurate.
Footnote: M4A moves the convo forward - but isn't workable as outlined so far b/c it truncated debate on price.
Saying that UHC is only achievable in some archive of history isn't accurate.
Footnote: M4A moves the convo forward - but isn't workable as outlined so far b/c it truncated debate on price.
There is NO "perfect" system. Every system has tradeoffs - BUT - there's a core principal that underlies the polarized thinking we're living with today:
UC: HC is a basic human right.
Current system: HC has to be an earned privilege.
We can easily afford the former. The latter is bankrupting us.
UC: HC is a basic human right.
Current system: HC has to be an earned privilege.
We can easily afford the former. The latter is bankrupting us.
December 11, 2025 at 12:15 AM
There is NO "perfect" system. Every system has tradeoffs - BUT - there's a core principal that underlies the polarized thinking we're living with today:
UC: HC is a basic human right.
Current system: HC has to be an earned privilege.
We can easily afford the former. The latter is bankrupting us.
UC: HC is a basic human right.
Current system: HC has to be an earned privilege.
We can easily afford the former. The latter is bankrupting us.
Glad you asked ;-) Since the failure of iPatient.com (2011) as committed as ever (incl book Casino Healthcare in 2015) to arguing for *systemic* healthcare reform to change this trajectory.
Tweaks around the edges (incl cash pricing) won't cut it b/c that's just a very old GOP fantasy.
#Medsky
Tweaks around the edges (incl cash pricing) won't cut it b/c that's just a very old GOP fantasy.
#Medsky
December 10, 2025 at 7:53 PM
Glad you asked ;-) Since the failure of iPatient.com (2011) as committed as ever (incl book Casino Healthcare in 2015) to arguing for *systemic* healthcare reform to change this trajectory.
Tweaks around the edges (incl cash pricing) won't cut it b/c that's just a very old GOP fantasy.
#Medsky
Tweaks around the edges (incl cash pricing) won't cut it b/c that's just a very old GOP fantasy.
#Medsky
Naturally, oligarchs hate any notion of tax reform - BUT - for systemic change to healthcare - tax reform will be required.
... starting w/ the HUGE tax exclusion corps get for "providing" expensive AND uncapped health benefits.
#Medsky
... starting w/ the HUGE tax exclusion corps get for "providing" expensive AND uncapped health benefits.
#Medsky
December 10, 2025 at 3:19 PM
Naturally, oligarchs hate any notion of tax reform - BUT - for systemic change to healthcare - tax reform will be required.
... starting w/ the HUGE tax exclusion corps get for "providing" expensive AND uncapped health benefits.
#Medsky
... starting w/ the HUGE tax exclusion corps get for "providing" expensive AND uncapped health benefits.
#Medsky
Because you're comparing the cash price of individual generics to an entire system that has to deliver Rx (branded AND generic) to 65M Americans.
AND - many generics are less than the $5 Cost-Plus Drugs charges - just for shipping.
Siphoning margin off generics also has a nasty consequence.
AND - many generics are less than the $5 Cost-Plus Drugs charges - just for shipping.
Siphoning margin off generics also has a nasty consequence.
December 9, 2025 at 7:20 AM
Because you're comparing the cash price of individual generics to an entire system that has to deliver Rx (branded AND generic) to 65M Americans.
AND - many generics are less than the $5 Cost-Plus Drugs charges - just for shipping.
Siphoning margin off generics also has a nasty consequence.
AND - many generics are less than the $5 Cost-Plus Drugs charges - just for shipping.
Siphoning margin off generics also has a nasty consequence.
... including evidence this week at the FIFA event ... definitely a bandage ...
December 7, 2025 at 5:22 PM
... including evidence this week at the FIFA event ... definitely a bandage ...
FWIW - I'm not the only one to see the congitive dissonance of @mcuban.bsky.social wanting to somehow eliminate insurance - but then announcing a partnership this week w/ Humana.
I guess the big healthcare disruption happens *after* you scale profits?
#Medsky
I guess the big healthcare disruption happens *after* you scale profits?
#Medsky
December 7, 2025 at 5:14 PM
FWIW - I'm not the only one to see the congitive dissonance of @mcuban.bsky.social wanting to somehow eliminate insurance - but then announcing a partnership this week w/ Humana.
I guess the big healthcare disruption happens *after* you scale profits?
#Medsky
I guess the big healthcare disruption happens *after* you scale profits?
#Medsky
I get the frustration - really I do - but your individual "benefit" isn't w/o a broader consequence.
Just b/c you don't see that consequence doesn't mean it won't affect you. That's my point.
Our Casino Healthcare pits each group against each other and the costs just keep accelerating.
#Medsky
Just b/c you don't see that consequence doesn't mean it won't affect you. That's my point.
Our Casino Healthcare pits each group against each other and the costs just keep accelerating.
#Medsky
December 6, 2025 at 1:45 PM
I get the frustration - really I do - but your individual "benefit" isn't w/o a broader consequence.
Just b/c you don't see that consequence doesn't mean it won't affect you. That's my point.
Our Casino Healthcare pits each group against each other and the costs just keep accelerating.
#Medsky
Just b/c you don't see that consequence doesn't mean it won't affect you. That's my point.
Our Casino Healthcare pits each group against each other and the costs just keep accelerating.
#Medsky
It's not zero-sum technically, but it is practically b/c if margins (already thin for generics) falls too low - a manufacturer will simply stop making a low-margin generic Rx for one that's higher margin.
So yea - shortages will result.
So yea - shortages will result.
December 2, 2025 at 7:03 AM
It's not zero-sum technically, but it is practically b/c if margins (already thin for generics) falls too low - a manufacturer will simply stop making a low-margin generic Rx for one that's higher margin.
So yea - shortages will result.
So yea - shortages will result.
... doesn't *seem* pointless ... until you realize that while SOME will benefit from cash-priced Rx - other's are likely to see higher prices - and when you siphon margins in one direction - there will be consequences ...
#Medsky
#Medsky
December 2, 2025 at 3:17 AM
... doesn't *seem* pointless ... until you realize that while SOME will benefit from cash-priced Rx - other's are likely to see higher prices - and when you siphon margins in one direction - there will be consequences ...
#Medsky
#Medsky
Making money - the old-fashioned way ...
November 16, 2025 at 5:32 PM
Making money - the old-fashioned way ...
Sure - it will take *some* time - BUT it IS doable. The GOP keeps delaying b/c they know the revenue hits will be *siesmic.*
FWIW: China went from ~50% coverage in 2005 to 95% in 2011. 6 years.
Quality wasn't great in 2011 - but it has improved considerably over the last 14 years.
#Medsky
FWIW: China went from ~50% coverage in 2005 to 95% in 2011. 6 years.
Quality wasn't great in 2011 - but it has improved considerably over the last 14 years.
#Medsky
November 6, 2025 at 3:15 AM
Sure - it will take *some* time - BUT it IS doable. The GOP keeps delaying b/c they know the revenue hits will be *siesmic.*
FWIW: China went from ~50% coverage in 2005 to 95% in 2011. 6 years.
Quality wasn't great in 2011 - but it has improved considerably over the last 14 years.
#Medsky
FWIW: China went from ~50% coverage in 2005 to 95% in 2011. 6 years.
Quality wasn't great in 2011 - but it has improved considerably over the last 14 years.
#Medsky
THERE ARE NO SHORTAGES OF IDEAS.
UNLESS YOU'RE A BILLIONAIRE - ALMOST EVERY OTHER HEALTHCARE SYSTEM IN THE WORLD IS 10X BETTER THAN OUR CASINO HEALTHCARE!
THIS QUOTE FROM @lessig.bsky.social IS OUR BIG CHALLENGE.
SO - @mcuban.bsky.social - WHAT'S *YOUR* PLAN/STRATEGY TO OVERCOME THIS HURDLE?
UNLESS YOU'RE A BILLIONAIRE - ALMOST EVERY OTHER HEALTHCARE SYSTEM IN THE WORLD IS 10X BETTER THAN OUR CASINO HEALTHCARE!
THIS QUOTE FROM @lessig.bsky.social IS OUR BIG CHALLENGE.
SO - @mcuban.bsky.social - WHAT'S *YOUR* PLAN/STRATEGY TO OVERCOME THIS HURDLE?
November 6, 2025 at 2:56 AM
THERE ARE NO SHORTAGES OF IDEAS.
UNLESS YOU'RE A BILLIONAIRE - ALMOST EVERY OTHER HEALTHCARE SYSTEM IN THE WORLD IS 10X BETTER THAN OUR CASINO HEALTHCARE!
THIS QUOTE FROM @lessig.bsky.social IS OUR BIG CHALLENGE.
SO - @mcuban.bsky.social - WHAT'S *YOUR* PLAN/STRATEGY TO OVERCOME THIS HURDLE?
UNLESS YOU'RE A BILLIONAIRE - ALMOST EVERY OTHER HEALTHCARE SYSTEM IN THE WORLD IS 10X BETTER THAN OUR CASINO HEALTHCARE!
THIS QUOTE FROM @lessig.bsky.social IS OUR BIG CHALLENGE.
SO - @mcuban.bsky.social - WHAT'S *YOUR* PLAN/STRATEGY TO OVERCOME THIS HURDLE?
"Transparent" healthcare pricing isn't a problem b/c it isn't AGENCY to influence.
The only innovation w/ @costplusdrugs is a "for-profit" philanthropy.
SOME will benefit - others won't - and some will see shortages or higher prices for margin that get's siphoned off of Rx manufacturers.
#Medsky
The only innovation w/ @costplusdrugs is a "for-profit" philanthropy.
SOME will benefit - others won't - and some will see shortages or higher prices for margin that get's siphoned off of Rx manufacturers.
#Medsky
October 30, 2025 at 10:45 PM
"Transparent" healthcare pricing isn't a problem b/c it isn't AGENCY to influence.
The only innovation w/ @costplusdrugs is a "for-profit" philanthropy.
SOME will benefit - others won't - and some will see shortages or higher prices for margin that get's siphoned off of Rx manufacturers.
#Medsky
The only innovation w/ @costplusdrugs is a "for-profit" philanthropy.
SOME will benefit - others won't - and some will see shortages or higher prices for margin that get's siphoned off of Rx manufacturers.
#Medsky
Evidence. Where's the evidence?
NOT gross margin. Operating margin.
Take UHG ... the biggest/baddest of them all.
NOT gross margin. Operating margin.
Take UHG ... the biggest/baddest of them all.
October 24, 2025 at 5:32 AM
Evidence. Where's the evidence?
NOT gross margin. Operating margin.
Take UHG ... the biggest/baddest of them all.
NOT gross margin. Operating margin.
Take UHG ... the biggest/baddest of them all.
and you look like a dude hiding behind anon in pursuit of a political agenda.
Not hard to pull pre-tax op margin - that supports other evidence I've cited.
But the systemic flaw remains (tiered pricing) and even @costplusdrugs.com endorses pass-thru PBMs - so good luck trying to eliminate them.
Not hard to pull pre-tax op margin - that supports other evidence I've cited.
But the systemic flaw remains (tiered pricing) and even @costplusdrugs.com endorses pass-thru PBMs - so good luck trying to eliminate them.
October 24, 2025 at 3:49 AM
and you look like a dude hiding behind anon in pursuit of a political agenda.
Not hard to pull pre-tax op margin - that supports other evidence I've cited.
But the systemic flaw remains (tiered pricing) and even @costplusdrugs.com endorses pass-thru PBMs - so good luck trying to eliminate them.
Not hard to pull pre-tax op margin - that supports other evidence I've cited.
But the systemic flaw remains (tiered pricing) and even @costplusdrugs.com endorses pass-thru PBMs - so good luck trying to eliminate them.
You're math ain't mathing ...
1. It's 2-4% operating margin (which is pre-tax)
2. PBMs DO add value.
3. PBMs see road ahead - and it ain't rebate roulette.
The flaw is our system of tiered coverage. We could end that. We should end it - but until we do - somebody's gotta match Rx to coverage.
1. It's 2-4% operating margin (which is pre-tax)
2. PBMs DO add value.
3. PBMs see road ahead - and it ain't rebate roulette.
The flaw is our system of tiered coverage. We could end that. We should end it - but until we do - somebody's gotta match Rx to coverage.
October 23, 2025 at 11:52 PM
You're math ain't mathing ...
1. It's 2-4% operating margin (which is pre-tax)
2. PBMs DO add value.
3. PBMs see road ahead - and it ain't rebate roulette.
The flaw is our system of tiered coverage. We could end that. We should end it - but until we do - somebody's gotta match Rx to coverage.
1. It's 2-4% operating margin (which is pre-tax)
2. PBMs DO add value.
3. PBMs see road ahead - and it ain't rebate roulette.
The flaw is our system of tiered coverage. We could end that. We should end it - but until we do - somebody's gotta match Rx to coverage.
Popular GOP thinking, but the evidence doesn't support the argument.
The evidence? PBM's make money - sure - but even if you eliminated them - you wouldn't save much - or enough. PBM operating margin is ~2-4%.
Reality is that our Rx pricing problem is WAY bigger than just generics & PBMs.
The evidence? PBM's make money - sure - but even if you eliminated them - you wouldn't save much - or enough. PBM operating margin is ~2-4%.
Reality is that our Rx pricing problem is WAY bigger than just generics & PBMs.
October 23, 2025 at 5:18 PM
Popular GOP thinking, but the evidence doesn't support the argument.
The evidence? PBM's make money - sure - but even if you eliminated them - you wouldn't save much - or enough. PBM operating margin is ~2-4%.
Reality is that our Rx pricing problem is WAY bigger than just generics & PBMs.
The evidence? PBM's make money - sure - but even if you eliminated them - you wouldn't save much - or enough. PBM operating margin is ~2-4%.
Reality is that our Rx pricing problem is WAY bigger than just generics & PBMs.