Rob

Ro, I like you. You know that. But you need to read the state of the state. The number of Deca Unicorns in Cali is growing by the day as investors chase amazing startups. A unique feature of these 10b startups is that even if they raise a billion, little, if any of that money goes to the founders, who are now worth billions of dollars over night. They are the definition of cash poor, stock rich How are you going to tax them ? Make them borrow money against their shares, if they can? They just raised money to grow their company and a bank will come along and loan them money ? A company that has been in business maybe less than a year ? lol Will you take their stock if they can’t ? Do you really think each of multiple founders, who started an amazing company in Cali and is now a billionaire, can each just pull out $250m per billion of net worth from their raise ? You know they can’t. If this passes , and it doesn’t directly impact me at all, I won’t be a cali resident, but you can bet if I’m investing in a multi billion dollar startup, I’m asking them to move from California first. IMO, if this passes, only idiot startup founders stay in Cali. I’ve done it before and will do it again. Dallas. Pittsburgh. Indiana. I will make NOT being in California a pre requisite for an investment Ideology is not a strategy Ro.

Explainer: If you need care and you can't afford your deductible, you will have to borrow money to pay for it. Typically the healthcare provider will loan you the money. Why ? They want to get your insurance company's money. Now, by definition, the hospital is a subprime lender. Not only is the patient in a huge financial hole, across their similarly situation patients, so is the hospital. They know they won't collect however much your deductible is. And that's just for your in-network deductible, nor does it account for your family max out of pocket I don't know the % of bankruptcies this causes What I do know is that the loss of hundreds of billions of dollars for patients and hospitals, starts with the plans offered by insurance companies. They know damn well when someone picks a plan and they can't afford the deductible. And to them, it's not a bad thing. If you can't afford your deductible, the chances they pay anything from your premiums, go way way down So patients go broke or can't afford care. Hospitals have huge uncollected debt, so they make it up elsewhere And then they aggregate those amounts, among others, and use them to get payments from state and federal programs. See how all that works together ?

Capitalism is the solution in healthcare. But, there is a reason we have anti-trust laws. There are reasons why we have the @FTC We are at a point in time where the big vertically integrated carriers and providers are abusing their market positions. Neither agency has done shit to stop them over the past decade There is a bill, the Break Up Big Medicine Bill from @HawleyMO and @SenWarren. I have talked to democratic senators who have said they will support it if more republican senators do. They want to match 1 dem to 1 rep. Totally dumb shit. So they say nothing. Other than Josh, not a single republican senator I have talked to has the guts to stand up for it. Period. They won’t give a reason. They just won’t do it. If you want less government in healthcare, it can’t happen until these conglomerates are broken up If you want single payer or M4A , it can’t happen until these conglomerates are broken up Quit bitching and call your senator and tell them to grow a spine and support this bill

If you want more doctors doing house calls, not selling their practices and going to work for the big HC conglomerates, make public med school free. A little gov intervention, so that rather than having 100s of thousands in debt guiding their decisions , they can do primary care or be a family physician and spend as much time with patients as they want. They can take cash. They can take chickens. If you had 250k after almost a decade of school, do you think that would impact your decisions ? And if you own a big HC conglomerate, does knowing they are drowning in debt impact your decision and how you compete and contract with them ? Fuck yeah it does. You pressure them till they have to sell out to you in an acquihire. They can’t afford to survive on their own and every huge HC company takes advantage of them About 32k students enter med school and DO school a year. 75k for a grant each. Thats 2.4b annually for each class. That’s it. You want better healthcare for everyone. That’s the place to start.

Let me give you an example of where there is no gov intervention, and the impact on brand drug pricing. When a brand manufacturer sells a drug to one of the big 3 drug distributors that control more than 90 pct of their market, those multi hundred billion dollar distributors DONT negotiate the lowest price they can get. They literally pay retail price. Then, in exchange for paying promptly, and providing some data, they get a discount of a whopping 5 pct. For a $600 drug, their net cost is $570 For obvious reasons, that distributor can’t sell to your local pharmacy for less than $570. So when you go to buy that drug, and have no insurance, or a deductible of more than $600, that’s why you pay the full $600. The question is “why would multi hundred billion dollar distributors only negotiate a 5% discount on brand drugs?” I asked this very question to several CEOs of brand drugs companies First you have to know that the pharma companies don’t keep that full $570. Because they pay rebates and fees to the big insurance company PBMs , they end up netting about 50% , or $300 in this example I asked them why they didn’t sell to the big distributors at a little more than their net price, which would allow them to make more money. And it would also allow the distributors to sell to pharmacies at say $350 (so the distributors make more money ), and the pharmacies could sell to the uninsured and those during their deductible phase for $375. Meaning more patients could benefit from their drugs. This doesn’t mean every patient could afford their meds, but it means that more could. Saving $225 is not nothing. The CEOs each told me that they would like to, but can’t. Why? Because the ins company PBMs have told them that if they did this , they would reduce their position on their formularies. Which could cost them billions of dollars across all their drugs. None of this is against the law. It’s become standard industry practice. Until we break up these conglomerates , it will only get worse.