Fraud in medicine is so curious. Here is a clip of @DrOz and @SenWarren agreeing that up-coding by the insurance companies that run Medicare Advantage Is fraud youtube.com/watch?v=fIX-XjmW… 1/6 🧵

Everything in the hospital could cost $1, and the insurance companies conglomerates would buy them, raise prices, and make sure their top and bottom lines grew I'm not saying hospital systems are innocent, far from it. But the big vertically integrated insurance companies create the annual plans that crush people's financial situation

TRICARE got robbed in broad daylight and nobody at the Pentagon can be bothered to look up from their coffee. Sen. Warren put the receipts on the table last week (5.22.26 hearing) and what came out of that room should be on the front page of every paper in the country. According to The Lever / Fed. News Net., Express Scripts' own pharmacy charges the DOD an average of $484 EXTRA on every generic prescription compared to what independent pharmacies get reimbursed. On MILLIONS of scripts. Every year. Do the math and you start to see the size of the hole that's being drilled into the defense health budget. Here's the trick they're running: Express Scripts is the PBM that runs the TRICARE pharmacy network. They've held that contract since 2009. Cigna bought them in 2018. The same company that decides what every pharmacy gets paid… also owns its own mail-order pharmacy that competes in the same network. So they set the price, they pay the bill, and the check lands in their own pocket. Pentagon → Express Scripts → Express Scripts. Rigged. Real example. Ezetimibe (generic Zetia, cholesterol med): — Independent pharmacy fills the script: reimbursed $0. Not a typo. Zero. — Express Scripts' OWN mail-order pharmacy fills the exact same script: pays itself $1,000. Same pill. $1,000 difference. Taxpayer funded. The consequence is exactly what you'd expect: ~13,000 pharmacies have walked away from the TRICARE network since 2022. That's nearly 1 in 6 independent pharmacies in the entire country. Military families and veterans are watching their local pharmacy options collapse because Express Scripts offered terms so bad nobody could afford to stay. When Sen. Warren asked Assistant Secretary Stephen Bass about the cost, his answer was basically "I'm not aware." Nine million TRICARE beneficiaries, billions of dollars, and the guy whose desk it sits on hasn't bothered to check the price. He'd notice real fast if it was his own credit card. And in case anyone thinks this is just bad management — there's an active whistleblower lawsuit alleging BILLIONS in fraud against Express Scripts and Accredo. The federal government has paused payments to other vendors for far, far less. So here's the message that needs to land on Secretary @RobertKennedyJr's desk: Cancel the payments. The $4.3B TRICARE contract is up for revision annually until 2029. There is a lever. Pull it. Demand a real audit. DOD has refused to check pricing since the 2021 contract. Warren got a commitment on 5.22.26 — now make it happen. Criminal charges. If the whistleblower allegations hold up, this isn't a billing dispute. It's looting a military health program. And @NickShirley — you exposed $9 billion in Medicaid daycare fraud in Minnesota and got the feds to freeze payments statewide off ONE investigation. 134M+ views. This is the same playbook, bigger target, bigger stakes — 9 million military families and vets, tens of billions a year, and a single address worth driving to: 1 Express Way, St. Louis, MO 63121. Go expose this. People should be losing their minds over this.

You aren't wrong that premiums are a healthcare tax, of which a too high percentage goes to the insurance conglomerates. But you left out a lot of important information 1. Who would run M4A, and how would that person(s) be selected and how often? Right now the Sec of HHS has discretion over everything, and we appoint a new one every 4 to 8 years, or more.. The implications are obvious. 2. What is not covered ? Is every $4m therapy going to be covered ? Even when you negotiate, it won't be cheap. What about the most expensive life saving equipment? It's not like the feds are good at negotiating healthcare 3. Who gets paid less ? Doctors ? Nurses? Specialists? 4. You assume employers will pass along what they don't pay for their share of benefits, to the employee. Do you live in the USA ? This assumption is unfortunately laughable and nothing in an M4A bill can change that 5. Much of medicare/medicaid is run by outside companies. Many of whom are the very worst actors in the healthcare industry. How do you replace them all ? How many years do you think that will take ? or Do you expect them all to become good actors and do the right thing rather than try to maximize earnings? 6. Hospitals don't know what their procedures cost them to perform. They use derivative cost accounting like cost to charge ratios, or, only show Medicare Cost Reports, and basically just look at how much cash they have on their books. Which is one of the reasons they are able to say they don't make money from Care/Caid patients. I don't think many understand what the concept of margin contribution is. If they don't know what their costs are, and you don't know what the actual costs are, how are you going to be able to work from a budget to determine total costs ? That said, Im for Universal Coverage. But till you know what it actually costs to deliver care in this country, its going to be near impossible to make work How do other countries do it ? Most started on this 30 years or more ago. Pre MRI machines. Pre Cell and Gene Therapies. They were able to start at a time when healthcare was much simpler, and evolve, some successfully, some less so, from that point. This is my opinion. If you disagree with any of it, happy to read it here

Unless our Medical Schools do a better job of screening admission candidates, we won’t have any Doctors. If you don’t want to practice FULL time for at least 20-25 years, pick another profession.

𝐈𝐦𝐚𝐠𝐢𝐧𝐞 𝐢𝐟 𝐫𝐞𝐬𝐭𝐚𝐮𝐫𝐚𝐧𝐭𝐬 𝐨𝐩𝐞𝐫𝐚𝐭𝐞𝐝 𝐥𝐢𝐤𝐞 𝐡𝐞𝐚𝐥𝐭𝐡 𝐬𝐲𝐬𝐭𝐞𝐦𝐬. You’d be seated by a broker your employer chose. The menu would have no prices. The bill would arrive three months later, itemized in a language only the restaurant speaks. And if you complained, a lobbyist would explain that food is too important to be left to the market. The absurdity sounds like satire because every normal industry would reject it immediately. In healthcare, it is the operating model. The patient never sees the price. The physician rarely sets it. The employer outsourced the choice to a broker paid by the carrier. The bill is adjudicated by 🐂💩against a chargemaster and then reverse engineered from a Medicare schedule written by a private committee, the RUC, the government rubber-stamps. Every layer between the person eating and the person cooking is a regulated rent. We’ve spent 50 years debating whether healthcare is too capitalist or too socialist. The better question is: who benefits from making comparison impossible? CON laws. Facility fees. Opaque chargemasters. Laws protected by paid politicians. Broker-controlled benefits. Gag clauses. Non profit / tax exempt nonsense accounting. GME caps. $257 Billy in subsidies! Each one is defended as protection. Each one functions as inventory control. The fix is restoring the basic conditions of exchange: a buyer who can see the price, a seller who can set it, and a shelf the law permits to exist. All I want is freedom from tyranny!

If insurance companies can deny care and call it "medically unnecessary", why aren't they required to have malpractice insurance doe when they get it wrong and someone gets sicker or tragically dies ?

Fantastic news, the great @caseybmulligan moves from SBA to HHS, which is where the money is. "HHS has appointed Casey Mulligan as chief economist and chief regulatory officer. He'll advise Health Secretary Robert F. Kennedy Jr. and other agency leaders on affordability issues."

Every major payer in America has filed a position on whether physicians can own hospitals. The physicians themselves have not. That’s how Section 6001 has survived fifteen years. Now is your opportunity… buff.ly/ESDn2Ue

I really like this idea. We've trained people and many employers to be completely passive about healthcare. Just hand over the premiums, cross our fingers, and hope the insurer doesn't screw us when we actually need it. That's why so few people even bother appealing denials. Insurance companies think in 12-month increments because that's how their risk pools and quarterly numbers work. They have zero incentive to invest in someone's long-term health. What you're describing flips that completely. It puts people back in the driver's seat as the actual CEOs of their own healthcare. Instead of renting protection from a middleman every month, you're building something real with your own money. The DPC gives you a doctor who actually knows you, the stop-loss handles the nightmare scenarios, and the rest sits in your account hopefully growing and earning some interest if you stay healthy. The stop-loss component even gets rid of the need for catastrophic coverage? I'm glad you're thinking beyond the employer-dictated model. I wish healthcare was not tied to your employer. My dad was a type 1 diabetic his whole life, and his biggest stress was almost always "do I have a job with good insurance?" Before the ACA, it was basically impossible for someone like him to get covered at all. The fear of losing coverage tied people to jobs they hated and made every career move terrifying. Redirecting what employers already spend on premiums into these kinds of personal accounts could finally start breaking that grip while still giving companies a predictable, controlled way to support their people. Obviously plenty of details to hammer out but the core is powerful. It rewards staying healthy, encourages smarter spending, and actually builds wealth instead of just feeding the system. Tools and resources that help people think like owners instead of passive consumers? Curious how you'd see this working on the employer side? Could they just redirect their current contribution straight into the account?