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.
A 90,000 square foot ballroom will DWARF the White House (~55,000 square feet).
Can his ambitions for Mount Rushmore be far behind?
#NoKings
Can his ambitions for Mount Rushmore be far behind?
#NoKings
October 21, 2025 at 6:15 PM
A 90,000 square foot ballroom will DWARF the White House (~55,000 square feet).
Can his ambitions for Mount Rushmore be far behind?
#NoKings
Can his ambitions for Mount Rushmore be far behind?
#NoKings
but so small scale as to be insignificant.
Yes, it WILL help SOME patients (mostly uninsured), but it will hurt others who will wind up paying more (in our zero-sum Casino Healthcare) - and even more w/ increasing Rx shortages.
When margins collapse - mfgs don't compete - they just walk away.
Yes, it WILL help SOME patients (mostly uninsured), but it will hurt others who will wind up paying more (in our zero-sum Casino Healthcare) - and even more w/ increasing Rx shortages.
When margins collapse - mfgs don't compete - they just walk away.
October 20, 2025 at 2:14 AM
but so small scale as to be insignificant.
Yes, it WILL help SOME patients (mostly uninsured), but it will hurt others who will wind up paying more (in our zero-sum Casino Healthcare) - and even more w/ increasing Rx shortages.
When margins collapse - mfgs don't compete - they just walk away.
Yes, it WILL help SOME patients (mostly uninsured), but it will hurt others who will wind up paying more (in our zero-sum Casino Healthcare) - and even more w/ increasing Rx shortages.
When margins collapse - mfgs don't compete - they just walk away.
I'm saying there's a real arrogance to those who assume that b/c it's published on Medicare pages - seniors will automagically understand the potential risk - which is financial.
Saying you don't ask/care basically acknowledges that arrogance - yes.
.. and keep peddling Mark. You are good at it!
Saying you don't ask/care basically acknowledges that arrogance - yes.
.. and keep peddling Mark. You are good at it!
October 8, 2025 at 3:03 PM
I'm saying there's a real arrogance to those who assume that b/c it's published on Medicare pages - seniors will automagically understand the potential risk - which is financial.
Saying you don't ask/care basically acknowledges that arrogance - yes.
.. and keep peddling Mark. You are good at it!
Saying you don't ask/care basically acknowledges that arrogance - yes.
.. and keep peddling Mark. You are good at it!
... and there's a real arrogance to those who assume that b/c it's published on a website - seniors are well aware AND fully understand ALL the details around LEP (not to mention Plan G - Medigap - coverage).
October 8, 2025 at 2:44 PM
... and there's a real arrogance to those who assume that b/c it's published on a website - seniors are well aware AND fully understand ALL the details around LEP (not to mention Plan G - Medigap - coverage).
.. and speaking of evidence - here's a couple of data points on just how well those 65+ understand even basic Medicare ... so I'm sure there's a complete and full understanding of the risk of LEP as it relates to Part D drug coverage.
[2021 survey of 2,000 seniors 65+]
[2021 survey of 2,000 seniors 65+]
October 7, 2025 at 4:09 PM
.. and speaking of evidence - here's a couple of data points on just how well those 65+ understand even basic Medicare ... so I'm sure there's a complete and full understanding of the risk of LEP as it relates to Part D drug coverage.
[2021 survey of 2,000 seniors 65+]
[2021 survey of 2,000 seniors 65+]
I know you don't ask - or care - but this is where your ignorance around drug coverage puts seniors at very real fiscal risk.
There is ABSOLUTELY a Medigap Drug Deductible penalty - AND - when it hits - it's in PERPETUITY!
There is ABSOLUTELY a Medigap Drug Deductible penalty - AND - when it hits - it's in PERPETUITY!
October 7, 2025 at 2:36 AM
I know you don't ask - or care - but this is where your ignorance around drug coverage puts seniors at very real fiscal risk.
There is ABSOLUTELY a Medigap Drug Deductible penalty - AND - when it hits - it's in PERPETUITY!
There is ABSOLUTELY a Medigap Drug Deductible penalty - AND - when it hits - it's in PERPETUITY!
... but facts don't support their agenda so they lie.
The fear of "socialized medicine" goes back to the 1940's - and it's a playbook that's worked ever since.
The fear of "socialized medicine" goes back to the 1940's - and it's a playbook that's worked ever since.
October 6, 2025 at 8:14 PM
... but facts don't support their agenda so they lie.
The fear of "socialized medicine" goes back to the 1940's - and it's a playbook that's worked ever since.
The fear of "socialized medicine" goes back to the 1940's - and it's a playbook that's worked ever since.
Fiscal is often the biggest component to political reasoning/rationale.
Universal health coverage (UHC) would erase a LOT of profits - and the GOP has successfully argued against UHC as "socialized medicine" going back to the 1940's.
Universal health coverage (UHC) would erase a LOT of profits - and the GOP has successfully argued against UHC as "socialized medicine" going back to the 1940's.
October 6, 2025 at 8:09 PM
Fiscal is often the biggest component to political reasoning/rationale.
Universal health coverage (UHC) would erase a LOT of profits - and the GOP has successfully argued against UHC as "socialized medicine" going back to the 1940's.
Universal health coverage (UHC) would erase a LOT of profits - and the GOP has successfully argued against UHC as "socialized medicine" going back to the 1940's.
Sadly - no. Further away.
The ACA was a step out of our wilderness - but the GOP is hell-bent on killing it.
After 50 attempts - GOP couldn't kill it legislatively - so they're gonna kill it fiscally.
Sadder still is just how much cheaper universal health coverage is.
The ACA was a step out of our wilderness - but the GOP is hell-bent on killing it.
After 50 attempts - GOP couldn't kill it legislatively - so they're gonna kill it fiscally.
Sadder still is just how much cheaper universal health coverage is.
October 6, 2025 at 7:50 PM
Sadly - no. Further away.
The ACA was a step out of our wilderness - but the GOP is hell-bent on killing it.
After 50 attempts - GOP couldn't kill it legislatively - so they're gonna kill it fiscally.
Sadder still is just how much cheaper universal health coverage is.
The ACA was a step out of our wilderness - but the GOP is hell-bent on killing it.
After 50 attempts - GOP couldn't kill it legislatively - so they're gonna kill it fiscally.
Sadder still is just how much cheaper universal health coverage is.
Yes - FISCAL health policy is about ACA tax credits and costs to government ..
.. but there's a MORAL health policy that keeps getting ignored/subverted.
Is healthcare a basic, fundamental human right? Or is it a privilege?
We can easily afford the former and the latter is bankrupting us.
.. but there's a MORAL health policy that keeps getting ignored/subverted.
Is healthcare a basic, fundamental human right? Or is it a privilege?
We can easily afford the former and the latter is bankrupting us.
October 6, 2025 at 5:32 PM
Yes - FISCAL health policy is about ACA tax credits and costs to government ..
.. but there's a MORAL health policy that keeps getting ignored/subverted.
Is healthcare a basic, fundamental human right? Or is it a privilege?
We can easily afford the former and the latter is bankrupting us.
.. but there's a MORAL health policy that keeps getting ignored/subverted.
Is healthcare a basic, fundamental human right? Or is it a privilege?
We can easily afford the former and the latter is bankrupting us.
He is building mfg here in US (or has built) - but again - generics are NOT the big Rx pricing problem.
Generics represent enormous volume, but low margin - for ALL the players.
Mark's big innovation seems to be a for-profit philanthropy? Good for brand Cuban maybe - not for impacting Rx prices.
Generics represent enormous volume, but low margin - for ALL the players.
Mark's big innovation seems to be a for-profit philanthropy? Good for brand Cuban maybe - not for impacting Rx prices.
October 6, 2025 at 4:19 PM
He is building mfg here in US (or has built) - but again - generics are NOT the big Rx pricing problem.
Generics represent enormous volume, but low margin - for ALL the players.
Mark's big innovation seems to be a for-profit philanthropy? Good for brand Cuban maybe - not for impacting Rx prices.
Generics represent enormous volume, but low margin - for ALL the players.
Mark's big innovation seems to be a for-profit philanthropy? Good for brand Cuban maybe - not for impacting Rx prices.
It's all different when the risk is an Rx - and the "savings" are nominal or non-existent.
What Mark intentionally ignores is the effect of cash-pricing in our zero-sum Casino Healthcare. When margin is siphoned away from one entity in healthcare - they just raise prices in others - or walk away.
What Mark intentionally ignores is the effect of cash-pricing in our zero-sum Casino Healthcare. When margin is siphoned away from one entity in healthcare - they just raise prices in others - or walk away.
October 6, 2025 at 3:48 PM
It's all different when the risk is an Rx - and the "savings" are nominal or non-existent.
What Mark intentionally ignores is the effect of cash-pricing in our zero-sum Casino Healthcare. When margin is siphoned away from one entity in healthcare - they just raise prices in others - or walk away.
What Mark intentionally ignores is the effect of cash-pricing in our zero-sum Casino Healthcare. When margin is siphoned away from one entity in healthcare - they just raise prices in others - or walk away.
That's a GOP fiction.
In our system of tiered coverage - PBMs do add value - and extract a profit for that value - AND - there are 2 types of PBMs. Mark actually *endorses*pass-thru PBMs (tho its debatable if it actually saves money).
In our system of tiered coverage - PBMs do add value - and extract a profit for that value - AND - there are 2 types of PBMs. Mark actually *endorses*pass-thru PBMs (tho its debatable if it actually saves money).
October 6, 2025 at 3:08 PM
That's a GOP fiction.
In our system of tiered coverage - PBMs do add value - and extract a profit for that value - AND - there are 2 types of PBMs. Mark actually *endorses*pass-thru PBMs (tho its debatable if it actually saves money).
In our system of tiered coverage - PBMs do add value - and extract a profit for that value - AND - there are 2 types of PBMs. Mark actually *endorses*pass-thru PBMs (tho its debatable if it actually saves money).
The downside is that our healthcare system is zero-sum - and when a drug manufacturer loses margin for one/any drug - they either raise the price of other [branded] drugs - OR - they just stop manufacturing that drug altogether.
In Pharma world - generics are HUGE volume - but low margin business.
In Pharma world - generics are HUGE volume - but low margin business.
October 6, 2025 at 2:55 PM
The downside is that our healthcare system is zero-sum - and when a drug manufacturer loses margin for one/any drug - they either raise the price of other [branded] drugs - OR - they just stop manufacturing that drug altogether.
In Pharma world - generics are HUGE volume - but low margin business.
In Pharma world - generics are HUGE volume - but low margin business.
... in aggregate? ... from multiple sources? Yes - certainly more than a billionaire pushing a political agenda.
Direct/cash-pay isn't a solution for any of the systemic problems we have in healthcare - but it's *very* popular w/ the GOP b/c it keeps all the BIG profit channels humming.
Direct/cash-pay isn't a solution for any of the systemic problems we have in healthcare - but it's *very* popular w/ the GOP b/c it keeps all the BIG profit channels humming.
October 6, 2025 at 2:47 PM
... in aggregate? ... from multiple sources? Yes - certainly more than a billionaire pushing a political agenda.
Direct/cash-pay isn't a solution for any of the systemic problems we have in healthcare - but it's *very* popular w/ the GOP b/c it keeps all the BIG profit channels humming.
Direct/cash-pay isn't a solution for any of the systemic problems we have in healthcare - but it's *very* popular w/ the GOP b/c it keeps all the BIG profit channels humming.