The independent pharmacy I worked at just went out of business after 71 years, largely due to PBMs demanding mail order via OptumRx and Kaiser and DIR "fees" on required brand name drugs. I wish I could send this video to every patient who doesn't understand why we had to close our doors. We were losing as much as $800 on a single prescription.
That's the way of it. We had two excellent local pharmacies, Phoenix and Webster's which are no more. Webster's had been in business since my grandfather's day. For a patient, perhaps the mail-order ones look the same, but as a physician, some of the best resources for sorting out medication questions, in the form of long experiences pharmacists are gone. And the world is now a little bit darker...
It's insane the government is so corrupt and selfish they back huge corporations that'll send the money overseas and underpay their staff over industrious hard working people who create good jobs and keep the money in their local economy. It's a giant fuck you to the working man, they abolished slavery but hell if they aren't bringing it right back in a roundabout way. I sometimes wish society would snap, collapse, just wipe out the way we live and turn their greedy ill gotten wealth into words in a history book. Folklore of a really barbaric time. But then I know innocent people would die and I have no idea what to think about this planet.
The US is not a really a developed country anymore, with their lack of a good healthcare system and their inhumane labor laws that don't protect their workers, I would say they stand very proudly next to the poorest dictatorships in the world. They are like one of those TikTok girls that use tons of make up, Hollywood level, and look like pure demons barefaced.
Now imagine every single sector of the economy working the same way! That's the goal! Use the laws as a weapon for the rich against the poor. Right now SCOTUS is hearing a case to see if the government has the right to regulate companies at all! Just like China! (edit: I'm not happy about this, it's sarcasm 🫠)
I love this 30 Days of US Healthcare series. It very directly exposes the fact that our healthcare system is run by unethical, greedy monopolies. It's disgusting.
As someone outside the US, wow this is insane... reminds me of just how politicians can also be bought or "lobbied" by large corporations to ensure future profits to the detriment of millions of regular people, also something that should be illegal but isn't somehow.
Why do you think it's different outside of the US? It's not. Either the government or your employer is taking large amounts of money out of your paycheck and the same bullshit is taking place. You just don't think about it because you dint get any monthly bills..
And that's not all: Even though it is perfectly legal for members of Congress to take huge amounts of money, expensive travel, and other gifts from corporate lobbyists and special interest group lobbyists, the politicians decided that letting drug reps leave little things at our offices like cheap disposable ballpoint pens and pads of sticky notes with the names of their drugs printed on them would be improper, as if those tiny trinkets were going to influence what we prescribe. I am all for the "Sunshine" laws that have to do with medical professionals owning stock in drug companies and medical device companies, and keeping track of how much money we are paid by those companies for honoraria when giving lectures, etc. But sticky notes? Give me a break. The hypocrisy of a politician being able to go on a golf trip to Scotland, worth tens of thousands of dollars and paid for by a lobbyist, while that same politician points the finger at us, accusing us of being so weak-minded that we would write for a brand name drug just because somebody left us $5.00 worth of sticky notes, is hilarious.
@@TakenTook I mean, just as long as we're in agreement that the solution here is for the same strict rules to apply to politicians, not that the rules for doctors should be laxer.
@@HeadsFullOfEyeballs -- Oh, I agree with that rule completely. And we are already complying with even the silliest of the rules, and most of us never bought stock in drug companies in the first place, even before the sunshine laws, because we knew it would be ethically improper. But politicians are very good at making sure they don't have to operate under the same rules as the rest of us.
He's prince of this world. Most healthcare workers don't even believe in God, then wonder why their world is screwed up. Hmmm. So intelligent, yet so blind.
In med school you really don't see any of this. When I ran an anesthesia group, I was exposed to how medical billing works, I sat on several hospital committees - including the pharmacy committee and medical executive committee, and I was in charge of selecting the health insurance plan for the group. Slowly you learn just how complicated / screwed up our system really is and you see how evil people sometimes end up in control of things.
Don't worry, you don't have to run your group any more. Private equity just bought it! (and is now getting sued by the FTC for monopolistic business practices)
As a current medical student I can affirm this is true. We even have a class labeled “the macro economics of healthcare” in which the first exam was entirely over the relationship between a career in medicine, the cost of health care in the US, and insurance companies. The most we were told is that the insurance companies protect doctor salaries and protect patients from higher taxes and healthcare only being accessible to the wealthy…. Like…. As a student informed about the world of healthcare from several views that’s blatantly false. But it’s being taught to my generation of upcoming physicians. They don’t want us to know how screwed doctors and patients alike truly are when it comes to how healthcare is paid for and provided. (From my understanding current outside research shows that insurance companies are the driving factor for inflation of healthcare costs (not spending but just costs) as well as the decline in physician take home compensation and reimbursement (under the guise of “salaries aren’t decreasing” because it’s the take home pay that’s dropping) Not that we’re being taught that though.
As a Canadian Nurse that worked in the USA for a period of time, it baffled me to learn that non medical insurance people made medical care decisions. It still baffles me how it was allowed. But I see in Canada certain politicians pushing words and ideas that reflect some US ideas that signal to me that some are willing to allow a 2 their system to emerge here for the wealthy vs evryone else. A slippery slope.
@@Therunner77452 I genuinely find this odd. My degree was in entertainment law and 60% of my course work was "corporate promoters are going to screw you, this is how you fight back". We had whole mock contract sessions where we would fight each other and pretend like we were going to counter sue. Probably why the writer's strike has teeth.
Unfortunately that really hasn't ever not been true in modern times. As much as people like to think that socialism removes this problem, there is always someone at the top profiting off those at the bottom. It's not impossible to change this of course, but it would require a major upheaval of how people tend to think in general since there will always be someone who finds a way to exploit the system otherwise
@@homerman76socialism can include democracy in the workplace, as opposed to the more authoritarian workplace where the owner/ceo has sole responsibility for setting wages & benefits. The definition of who's "on top" changes in a workplace democracy structured correctly & efficiently. the connotation that socialism also concentrates power in the same manner as capitalism is a false equivalence between socialism and authoritarian rule, one a restructuring of the ownership of the means of production & the other a power structure that's entirely separate from what mode of economics is being employed. Research 'Democratic Socialism'
@@johnw3772competition often sets it. A small example is where I live there's a Walmart and a home Depot. Walmart one day raised their base line wages drastically, like a 1/3 more. And instantly caused Home Depot to both loose employees and be unable to replace them because 500 feet away here's Walmart paying wildly more then Home Depot. This in turned forced Home Depot to pay more
@@SilverStarHeggisist you can also apply this logic to unions as displayed in the department of labor's recent report. As union's secure higher wages in contract negotiations, the non-unionized companies in that industry will have to compete with higher wages & benefits. This trend can be shown since the labor movement of the past century, and the wealth gap was shrinking until the dismantling of union power in past decades.
@@johnw3772I can see how democratically running a business can be beneficial, but not for everything. For example, the Runescape Classic developers let players vote on what changes / updates should be made to the game, and that works very well for them. But for other things, it doesn't make sense since the owner of a privately owned business is the one taking on the risk of millions of dollars with their business venture. Since they are taking on the risk, but the employees payment is guaranteed, it makes sense that the owner makes the decisions and the employee does the work they are told to do for the agreed upon payment. Imagine if a democratically managed company faces an OSHA violation or needs to pay workers compensation. Shouldn't every employee have their paycheck cut to pay for it, since they all share equal responsibility in having mismanaged the company? An LLC generally protects management from losing their own money, but when the company's reserves run dry, they have to downsize. Would you want to play a game of Survivor to see who gets voted out of the company so that everyone else keeps their paycheck consistent? People will form alliances / parties within the company and lead to more drama and conflict. Overall it doesn't sound worth it to me, and if I opened a business I definitely wouldn't let everything be managed via voting.
I cannot help but wonder how many UHC 'fixers' are developing plans to mitigate this troublesome doc. You have a talent for informing in a simplified way that even I can understand. This has to be creating a groundswell of anger and influence. I hope you are consulting with a good lawyer on how to create parody without liability. Remember that even John Oliver got SLAPPed, and UA-cam loves the ad revenue from big pharma. I don't want to be the wet blanket, but this series is incredibly good and may generate attention from the Eye of Pharma.
@@SportyMabamba Well, yeah, thanks to conservation of ninjutsu, every henchman you add makes the rest weaker. What he really has to worry about is the singular mafia boss who's 8 feet tall, with 400 pounds of pure muscle and an extremely flashy, colorful outfit (still no shirt tho)
Well written, funny, and infuriating. But most importantly of all...Eye opening. This project in of itself is doing great wonders to help with American health literacy. Thank you for your work.
UHC has one last branch to conquer, pharmaceuticals themselves. If you own the hospital, produce the medications, produce the equipment, insure the patient you control all stones like thanos and can jack up prices as you want
There's another front they probably went for instead. The wholesale warehousing drug companies that stock the pharmacies. Because then they get to pay themselves to stock their own pharmacies and control prices for your local competitors running them out of business.
As a primary care provider thank you for keeping me sane. My colleagues and I need this humor to keep our spirits up as we try to navigate this hellscape of a system for our patients
Can an alternative name for this series be "The Medical Mafia"? I'm half expecting UHC to put a horse head in my bed and call it an "alternative therapy"....
As a T1D I love when my ins switches covering Humalog to Novalog and I have to gert a new Rx for it because..of course they can't just have a blanket Rx for life saving meds
I recall when ACA was being debated and a public option was being discussed, one of the things they brought up was how many health insurance jobs could be lost. I feel like health insurance has either gotten so much worse since then or people like the good doctor have educated us on things we were oblivious too. At this point, they should be lucky if we don't charge them criminally.
You should throw in a video about the GPOs that make more admin fees for the PBMs. Emisar: handles the commercial negotiations on behalf of (owned by) Optum Rx. Headquartered in Ireland. Ascent: handles commercial negotiations on behalf of (owned by) Express Scripts. Headquartered in Switzerland. Zinc: handles the commercial negotiations on behalf of (owned by) CVS. Headquartered in Delaware. These three companies (two of which are outside the US) control the pharmacy benefits for 80% of covered lives in the US.
Fun fact: almost every state mandates a specific pharmacist:technician ratio. It could be anywhere from 1:2 to 1:4 or maybe a little higher if the technician is certified. Do you know what state does not have a a specified pharmacist:technician ratio? Missouri. Guess who is headquartered in that state? The Express scripts, one of the largest PBMs in the nation. There’s a reason there’s no pharmacist:technician ratio and it’s because they have influence and can make more money without concern for safety.
You recently made one about how adults lose coverage under their parent's health insurance plans after turning 26, but I actually lost my health insurance at 19 because I moved to a different county to attend university (in the same state). My family was low-income at the time and qualified for Medi-Cal (California's federally funded insurance plan for low income individuals), and apparently it is county-specific. Students had to pay several thousand dollars per semester for insurance, and there was actually a document floating around about how to answer the questions on the waiver form correctly so that the form doesn't get rejected. The best part? I had to withdraw for medical reasons in my third year of university, and lost the university health insurance. I was uninsured and couldn't get any treatment or medical clearance documents that I needed to re-enroll. I applied for Medical as a low income student (an option that I was uninformed about previously), and the process took months. I got two infections (UTI and strep throat) during that time and had to pay more than one thousand dollars for treatment. I was told that Medi-cal would cover the cost once it became active, only to find out later that the hospital that I was treated at doesn't accept Medi-Cal.
I work in pharmacy, this is extremely true. Sadly, patients will take it out on us. If I had a nickel everything I have to say we don't determine the copays or having to explain their insurance to them, I would never have to work again. "Drug not formulary." "Prior authorization required." "Pharmacy not contracted." " After first fill, must use mail order." Also having patients wanting us to "price match" their copays to their preferred pharmacy, like what? You have a cheaper copay at that preferred pharmacy because they probably paid your insurance a crap ton of money to make sure you use their pharmacies. Or like this case, they're the same company.
Yes, it's the height of immorality! I'm elderly; I don't have that problem because I wouldn't touch a Medicare Advantage plan with a ten foot pole, as we used to say. I have original Medicare (plan F) and a supplemental policy with BCBS that covers everything that Medicare does not. I never see a bill or pay a co-pay or deductible and never have to fight with any insurance company or agency ever. it's all between the insurance companies and the providers. All I ever pay is premiums and part D deductible and co-pays. I live on $2,000 a month with a paid-off house and car. I prioritize my health that averages a total of about $500 a month instead of many things like tithing, charity, gifts, cable, smart phone, new clothes, eating out, hair cuts, magazines, impulse purchases, etc. I just don't buy anything I don't actually need. It can be done.
I was also wondering how this man is still alive&well in light of all his incredibly illuminating videos clearly outlining how US debt building erm i mean "health care" actually functions. Of course i wondered how George Carlin survived as long as he did given his proclivity for truth. Hats off to you, DocGlauc, and the odds will *always* be in Jonathan's favour!
Thank you so much for posting this series. It’s such a “fun” way to expose our system and desperately needed. I could go on and on in rage but seriously just thank you so much.
But if I as a physician send an Rx to pharmacy my wife works at as a pharmacist even if that was the patients choice and neither of us owns the pharmacy. We could be in trouble for self referral. Our system is beyond flawed thanks to Congress and Senate.
Reminds me of when AMR, the largest ambulance company in America, was able to propose a California proposition that allowed ambulance companies to waive EMS workers' off duty 15 min breaks and 30 min lunch breaks. They worded it in a way to appeal to the public, and it was voted in by the people. If you have enough money, you really do get to write the laws.
I love living in Australia. The Pharmaceutical Benefits Scheme keeps most medications covered to an affordable price, you can choose generic brands if you want and you can go to whatever pharmacy you choose. And if you're on a Health Care card for whatever reason, meds are capped at an even further discounted rate.
I take multiple medications daily and the prices are between $9-19 with no concession card (and if I had one all meds cap at $6). I have a friend who takes the same med in USA and its $80... I don't think I'd risk going on holiday to America in case something happened and I needed to get a script there...
Unless they suddenly decide to charge extra for the 'name brand' - and not everything is covered by PBS/healthcare card cap. That being said, we also have the Safety Net - if a healthcare card hold goes over $xxx paid on scripts, the subsequent scripts that you would normally pay $8- for, are 'free' til the end of the year. Some years I reach the safety net, others I don't; but I have also noticed a creep in medications that suddenly aren't covered, even just costing $15- - that don't count towards safety net, and will continue to cost after you reach it ... It's STILL a godsend compared to what the Americans have to endure 🤯
Reminds me of the time the Urban Affairs Minister wanted the Mayor's permission to permit real-estate in the eco-sensitive wetlands bordering our city. The Mayor in turn wrote to the Environment Minister for his expert opinion, to which he said yes. So the Mayor permitted the Urban Affairs Minister to go ahead.... Fun Fact : All the 3 guys above were in fact the one-and-same-person !!
CVS caremark denied chemo for my son with spinal cord tumors. I had to go to the media to get them to change their mind. My son is a huge fan and says the neurologist is spot on. He's 14.
I'm curious as to what Caremark's reasoning was for the denial. Was it the the specific type of chemo they were denying or just chemo in general? Best wishes for a successful recovery!!
My partner has BCBS and has taken Vyvanse for years, which they took off their 2023 formulary. His doctor was able to get a PA through (after trying 4 times) and they "generously" brought it down from about $421 to $80 Now that the generic is out, we were hoping that there would be more coverage. But nope. They don't cover it AT ALL. He'd have to pay the same amount he was having to pay for the name brand before the PA went through. Make it make sense. Can they even get kickbacks from something they took off their formulary?
They are greedy bastards. That's the only explanation. The US health care system is screwed, and health insurance companies are a blight on humanity. I hope your partner is doing well.
I have two versions of UHC... they 'heavily suggest' OptumRX and optum services, but I had never heard of them, and I never actually knew they were owned by UHC... but my UHC is medicare and medicaid and they can't restrict which pharmacies I use.
Of course the pharmacy benefit manager has a twirling handle bar mustache like an old timey villain. As someone who wants to work in a pharmacy setting it makes me sick knowing what I'll have to do and I hope to make a difference in patient care in the near future. Please raise awareness of our health crisis more!❤
It's so refreshing to know that after coming out of the doctors office feeling like it we were just rammed up the rear, that the system was built to actively increase the ramming. 😊
I would love to laugh at these, but being someone who has worked for a TPA and a medical billing company over the past 10 years, I know all of this is true.
Why are we just sitting back and taking this abuse? I can and do contact my representative and senators. I WILL contact them all about this, and link to this video. Thank you. You are providing a fantastic public service.
Funny thing is today UHC did a sneak change to its formulary and stopped covering diabetic test strips completely. When we called to ask if there is one covered, UHC said nope so have fun being a diabetic on Medicare.
When I was a kid my house was full of pens and note pads with pharmaceutical names on them (mom was a RN). I was a new nurse myself when the “drug swag” rules changed in 2009 and banned them. Over the next couple years I saw the pen cups in the nurses station dwindle and then disappear entirely. In the staff room there was a melamine dinner plate advertising Lexapro and I took it home as a soon-to-be-vintage novelty. I had it for more than 10 years before it finally broke. #RIPLexaplate The current rules: PhRMA's latest guidelines, effective January 2009, prohibit non-educational and practice-related gifts such as pens but continue to permit company-sponsored meals, drug samples, and other "educational"" gifts valued less than $100. National Institutes of Health
This put my family's pharmacy out of business, being in a small town it was hard on the community. The only other nearest pharmacy was a walmart pharmacy 30min away. That being said we had such a loyal customer base many of them that could afford it chose not to run their insurance so they wouldnt put us out of business, unfortunately we only lasted one year after that.
I was watching the episode from two days ago and this one and thinking "Geez, this kind of vertical integration has been illegal in the film industry for decades!" The film studios aren't allowed to own distribution companies or movie theaters. And then there it was: the very words "VERTICAL INTEGRATION" right in this vid! My jaw actually dropped.
Actually a few years ago the rule that film studios, distribution companies, and movie theatres can't be vertically integrated was rescinded. It hasn't led to any major market changes yet, but it did allow AMC to act as distributor for the Taylor Swift concert movie after the actual distributors only offered it time slots in 2024 and 2025, not this month like Taylor and her management wanted. AMC instead said yes, they could show it at the date they wanted and distribute it to other theatres, so now the only ones making money off what is most likely going to be rather successful (especially compared to the tiny budget concert movies tend to have) are the movie theatres and Swift.
@@seonor The idea that there might be one positive outcome doesn't change the fact that this was a monopolistic practice that had a massive stifling effect on the industry. It was crushingly oppressive to independent filmmakers, giving the major studios complete control over whether their films ever saw the light of day. It is shortsighted to think that the same thing won't happen again. Corporations have a way of treading lightly about such things, as none of them wants to be known for being the first to take such negative action, the likely explanation of the fact that there haven't been, as you noted, "any major market changes...YET." But once one does make use of the monopolistic power this provides them with, that opens the floodgates for them all to do so, too.
@@edmilham4172 Yes, of course it's a bad thing that the protections against monopolies are weakened or removed. I just thought it was mildly funny that it backfired in this one case.
And this is why a lot of independents will do cash price + dispensing fee. In the long run it’s cheaper for generics and no dir fees or clawbacks. Our governor here in KY I’d planning to change the pbms reimbursement for medicaid. Got to meet him a couple weeks ago.
Yup, vertical integration applies to Chile as well. Health Insurance companies are mandated to guarantee access to treatment for a list of diseases (you could call that a silverlining I guess), but then they are allowed to control which hospitals (99% of the times, private) you are allowed to go to with their insurance, and then they force you to only buy the allowed medications (99% of the times, brand name) in your treatment from certain pharmacies (one of which is owned by...Walgreens)
Your Sept series makes me feel like I’m watching a “True Crime” series. As one who’s experienced healthcare in Canada, Europe, and Australia, I have a chip on my shoulder every time I go to see a US doctor.
Ah yes, the joy of living in an oligarchy - as long as you have money, you are set. I'm a career counsellor outside the US (ie the civilised world), and I can help my clients find the best career for them, depending on their interests, abilities, all of that, with all the freedom in the world to decide. Had I been working in the US, my only advice to everyone would be ' make as much money you can in any way and screw your interests', and that terrifies me.
I love these videos. Low key, I hope one of these videos is about the Medicare Part D Late Enrollment Penalty because that penalty is total bullshit, lol 😝 Keep up the awesome work though. Your videos are always so informative and entertaining. 😄
My favorite part was in 2019 when Optum sued into the ground a industry distupting non-profit competitor for executive non-competes, breaches of contract, and trade secret violations.
At this point UHC is so profitable and integrated in too many parts of the healthcare system and have the resulting political influence to match that people speaking out against them don't actually matter much.
I've been following the videos. They are very good, very funny and very informative. But, you said it would be a fundraiser and I can't find any fundraiser link. Where is that?
I’m reposting this one for a couple reasons. #1 I don’t think I can explain PBMs any better than this and #2 this sets up tomorrows video nicely.
Have the insurance companies hired a hit man?
@@henrygingercatyes, it’s Satan. He’s right there above the CEO
It's an excellent skit, so no worries on that.
Thanks for clarifying, I think a lot of us either instantly noticed, or had the funny feeling
Thank you so much for these videos...the US healthcare system is disgusting. I'm worried they'll try and screw you for telling the truth!
The independent pharmacy I worked at just went out of business after 71 years, largely due to PBMs demanding mail order via OptumRx and Kaiser and DIR "fees" on required brand name drugs. I wish I could send this video to every patient who doesn't understand why we had to close our doors. We were losing as much as $800 on a single prescription.
Omg... 😰
That's the way of it. We had two excellent local pharmacies, Phoenix and Webster's which are no more. Webster's had been in business since my grandfather's day. For a patient, perhaps the mail-order ones look the same, but as a physician, some of the best resources for sorting out medication questions, in the form of long experiences pharmacists are gone. And the world is now a little bit darker...
Everyone I know goes to Mexico for their meds - no surprise
It's insane the government is so corrupt and selfish they back huge corporations that'll send the money overseas and underpay their staff over industrious hard working people who create good jobs and keep the money in their local economy.
It's a giant fuck you to the working man, they abolished slavery but hell if they aren't bringing it right back in a roundabout way.
I sometimes wish society would snap, collapse, just wipe out the way we live and turn their greedy ill gotten wealth into words in a history book. Folklore of a really barbaric time. But then I know innocent people would die and I have no idea what to think about this planet.
Well if you're going out of business, couldn't you send just 1 last mass e-mail to inform all your clients? Seems like you don't have much to loose?
To anybody who is in a developed country that is not USA. This is not exaggeration. This is true "for profit" healthcare
The US is not a really a developed country anymore, with their lack of a good healthcare system and their inhumane labor laws that don't protect their workers, I would say they stand very proudly next to the poorest dictatorships in the world. They are like one of those TikTok girls that use tons of make up, Hollywood level, and look like pure demons barefaced.
Now imagine every single sector of the economy working the same way! That's the goal! Use the laws as a weapon for the rich against the poor. Right now SCOTUS is hearing a case to see if the government has the right to regulate companies at all! Just like China!
(edit: I'm not happy about this, it's sarcasm 🫠)
That's why the USA isn't a developed country. It's three third world nations in a trenchcoat.
This is what the Tories in the UK want to York or NHS healthcare system into 😒
Yah it’s terrifying…
I love this 30 Days of US Healthcare series. It very directly exposes the fact that our healthcare system is run by unethical, greedy monopolies. It's disgusting.
As someone outside the US, wow this is insane... reminds me of just how politicians can also be bought or "lobbied" by large corporations to ensure future profits to the detriment of millions of regular people, also something that should be illegal but isn't somehow.
Why do you think it's different outside of the US? It's not. Either the government or your employer is taking large amounts of money out of your paycheck and the same bullshit is taking place. You just don't think about it because you dint get any monthly bills..
Because politicians are the ones who pass the laws
And that's not all: Even though it is perfectly legal for members of Congress to take huge amounts of money, expensive travel, and other gifts from corporate lobbyists and special interest group lobbyists, the politicians decided that letting drug reps leave little things at our offices like cheap disposable ballpoint pens and pads of sticky notes with the names of their drugs printed on them would be improper, as if those tiny trinkets were going to influence what we prescribe.
I am all for the "Sunshine" laws that have to do with medical professionals owning stock in drug companies and medical device companies, and keeping track of how much money we are paid by those companies for honoraria when giving lectures, etc.
But sticky notes? Give me a break.
The hypocrisy of a politician being able to go on a golf trip to Scotland, worth tens of thousands of dollars and paid for by a lobbyist, while that same politician points the finger at us, accusing us of being so weak-minded that we would write for a brand name drug just because somebody left us $5.00 worth of sticky notes, is hilarious.
@@TakenTook I mean, just as long as we're in agreement that the solution here is for the same strict rules to apply to politicians, not that the rules for doctors should be laxer.
@@HeadsFullOfEyeballs -- Oh, I agree with that rule completely. And we are already complying with even the silliest of the rules, and most of us never bought stock in drug companies in the first place, even before the sunshine laws, because we knew it would be ethically improper. But politicians are very good at making sure they don't have to operate under the same rules as the rest of us.
Ya know, Satan being the top of the US health Insurance crisis makes total sense
No it doesn't, Satan is evil but not United Healthcare evil. That's a different level.
sometimes i believe is the other way around
He's prince of this world. Most healthcare workers don't even believe in God, then wonder why their world is screwed up. Hmmm. So intelligent, yet so blind.
@@s1988teve They are living in an alternate reality.
@@s1988teve So smart, they’re stupid.
As a youth, I always fancied the idea of moving to the States. As an adult, I wouldn't do that, even if you paid me.
In med school you really don't see any of this. When I ran an anesthesia group, I was exposed to how medical billing works, I sat on several hospital committees - including the pharmacy committee and medical executive committee, and I was in charge of selecting the health insurance plan for the group. Slowly you learn just how complicated / screwed up our system really is and you see how evil people sometimes end up in control of things.
Don't worry, you don't have to run your group any more. Private equity just bought it!
(and is now getting sued by the FTC for monopolistic business practices)
The more complicated someone allows something to be or become, the more they are trying to hide from you.
As a current medical student I can affirm this is true. We even have a class labeled “the macro economics of healthcare” in which the first exam was entirely over the relationship between a career in medicine, the cost of health care in the US, and insurance companies. The most we were told is that the insurance companies protect doctor salaries and protect patients from higher taxes and healthcare only being accessible to the wealthy…. Like…. As a student informed about the world of healthcare from several views that’s blatantly false. But it’s being taught to my generation of upcoming physicians. They don’t want us to know how screwed doctors and patients alike truly are when it comes to how healthcare is paid for and provided.
(From my understanding current outside research shows that insurance companies are the driving factor for inflation of healthcare costs (not spending but just costs) as well as the decline in physician take home compensation and reimbursement (under the guise of “salaries aren’t decreasing” because it’s the take home pay that’s dropping)
Not that we’re being taught that though.
As a Canadian Nurse that worked in the USA for a period of time, it baffled me to learn that non medical insurance people made medical care decisions. It still baffles me how it was allowed. But I see in Canada certain politicians pushing words and ideas that reflect some US ideas that signal to me that some are willing to allow a 2 their system to emerge here for the wealthy vs evryone else. A slippery slope.
@@Therunner77452 I genuinely find this odd. My degree was in entertainment law and 60% of my course work was "corporate promoters are going to screw you, this is how you fight back". We had whole mock contract sessions where we would fight each other and pretend like we were going to counter sue. Probably why the writer's strike has teeth.
"you don't get to make 200 billion with oversight" best sadly true quote to summarize what's wrong with profit driven society
Unfortunately that really hasn't ever not been true in modern times. As much as people like to think that socialism removes this problem, there is always someone at the top profiting off those at the bottom. It's not impossible to change this of course, but it would require a major upheaval of how people tend to think in general since there will always be someone who finds a way to exploit the system otherwise
@@homerman76socialism can include democracy in the workplace, as opposed to the more authoritarian workplace where the owner/ceo has sole responsibility for setting wages & benefits. The definition of who's "on top" changes in a workplace democracy structured correctly & efficiently.
the connotation that socialism also concentrates power in the same manner as capitalism is a false equivalence between socialism and authoritarian rule, one a restructuring of the ownership of the means of production & the other a power structure that's entirely separate from what mode of economics is being employed. Research 'Democratic Socialism'
@@johnw3772competition often sets it. A small example is where I live there's a Walmart and a home Depot.
Walmart one day raised their base line wages drastically, like a 1/3 more. And instantly caused Home Depot to both loose employees and be unable to replace them because 500 feet away here's Walmart paying wildly more then Home Depot. This in turned forced Home Depot to pay more
@@SilverStarHeggisist you can also apply this logic to unions as displayed in the department of labor's recent report. As union's secure higher wages in contract negotiations, the non-unionized companies in that industry will have to compete with higher wages & benefits. This trend can be shown since the labor movement of the past century, and the wealth gap was shrinking until the dismantling of union power in past decades.
@@johnw3772I can see how democratically running a business can be beneficial, but not for everything. For example, the Runescape Classic developers let players vote on what changes / updates should be made to the game, and that works very well for them. But for other things, it doesn't make sense since the owner of a privately owned business is the one taking on the risk of millions of dollars with their business venture. Since they are taking on the risk, but the employees payment is guaranteed, it makes sense that the owner makes the decisions and the employee does the work they are told to do for the agreed upon payment. Imagine if a democratically managed company faces an OSHA violation or needs to pay workers compensation. Shouldn't every employee have their paycheck cut to pay for it, since they all share equal responsibility in having mismanaged the company? An LLC generally protects management from losing their own money, but when the company's reserves run dry, they have to downsize. Would you want to play a game of Survivor to see who gets voted out of the company so that everyone else keeps their paycheck consistent? People will form alliances / parties within the company and lead to more drama and conflict. Overall it doesn't sound worth it to me, and if I opened a business I definitely wouldn't let everything be managed via voting.
I cannot help but wonder how many UHC 'fixers' are developing plans to mitigate this troublesome doc. You have a talent for informing in a simplified way that even I can understand. This has to be creating a groundswell of anger and influence. I hope you are consulting with a good lawyer on how to create parody without liability. Remember that even John Oliver got SLAPPed, and UA-cam loves the ad revenue from big pharma. I don't want to be the wet blanket, but this series is incredibly good and may generate attention from the Eye of Pharma.
They probably have the Yakuza on speed dial in case he ever digs TOO deep.
@@notme8232Jonathan goes 60-0 versus a horde of mafia goons
think hes good. If he made 30 days of videos about dentists however...
well they can't give him testicle cancer, they'll probably have to send the tooth bros to break his legs.
@@SportyMabamba Well, yeah, thanks to conservation of ninjutsu, every henchman you add makes the rest weaker. What he really has to worry about is the singular mafia boss who's 8 feet tall, with 400 pounds of pure muscle and an extremely flashy, colorful outfit (still no shirt tho)
Well written, funny, and infuriating. But most importantly of all...Eye opening. This project in of itself is doing great wonders to help with American health literacy. Thank you for your work.
UHC has one last branch to conquer, pharmaceuticals themselves.
If you own the hospital, produce the medications, produce the equipment, insure the patient you control all stones like thanos and can jack up prices as you want
There's another front they probably went for instead. The wholesale warehousing drug companies that stock the pharmacies. Because then they get to pay themselves to stock their own pharmacies and control prices for your local competitors running them out of business.
And with a snap of their fingers can jack up prices higher than half the population can afford.
United Healthcare holding a pair of cutout horns: In my free time, I'm also Satan.
I actually thought that after seeing the chain of command, we’d see those horns instead of the mustache.
😂
As a primary care provider thank you for keeping me sane. My colleagues and I need this humor to keep our spirits up as we try to navigate this hellscape of a system for our patients
That last line… chills down my spine.
Can an alternative name for this series be "The Medical Mafia"? I'm half expecting UHC to put a horse head in my bed and call it an "alternative therapy"....
the "care" cartel
This is an insult to the mafia, really. They're far more forthright in their dealings than health insurance companies.
Shh! Don't give them ideas!
As a T1D I love when my ins switches covering Humalog to Novalog and I have to gert a new Rx for it because..of course they can't just have a blanket Rx for life saving meds
I recall when ACA was being debated and a public option was being discussed, one of the things they brought up was how many health insurance jobs could be lost. I feel like health insurance has either gotten so much worse since then or people like the good doctor have educated us on things we were oblivious too. At this point, they should be lucky if we don't charge them criminally.
Lol, poor health insurance jobs... We could definitely do with a few less of those!
You get to write the laws and choose which ones to obey.
And if you can't prevent a law, you just lobby for low fines, that way you don't have to care.
You can also kill off your smaller competition by making sure that they follow the laws which you don't!
You should throw in a video about the GPOs that make more admin fees for the PBMs.
Emisar: handles the commercial negotiations on behalf of (owned by) Optum Rx. Headquartered in Ireland.
Ascent: handles commercial negotiations on behalf of (owned by) Express Scripts. Headquartered in Switzerland.
Zinc: handles the commercial negotiations on behalf of (owned by) CVS. Headquartered in Delaware.
These three companies (two of which are outside the US) control the pharmacy benefits for 80% of covered lives in the US.
Fun fact: almost every state mandates a specific pharmacist:technician ratio. It could be anywhere from 1:2 to 1:4 or maybe a little higher if the technician is certified. Do you know what state does not have a a specified pharmacist:technician ratio? Missouri. Guess who is headquartered in that state? The Express scripts, one of the largest PBMs in the nation. There’s a reason there’s no pharmacist:technician ratio and it’s because they have influence and can make more money without concern for safety.
“How is any of this legal?!” That’s what I’ve been asking for years!
You recently made one about how adults lose coverage under their parent's health insurance plans after turning 26, but I actually lost my health insurance at 19 because I moved to a different county to attend university (in the same state). My family was low-income at the time and qualified for Medi-Cal (California's federally funded insurance plan for low income individuals), and apparently it is county-specific.
Students had to pay several thousand dollars per semester for insurance, and there was actually a document floating around about how to answer the questions on the waiver form correctly so that the form doesn't get rejected.
The best part? I had to withdraw for medical reasons in my third year of university, and lost the university health insurance. I was uninsured and couldn't get any treatment or medical clearance documents that I needed to re-enroll. I applied for Medical as a low income student (an option that I was uninformed about previously), and the process took months. I got two infections (UTI and strep throat) during that time and had to pay more than one thousand dollars for treatment. I was told that Medi-cal would cover the cost once it became active, only to find out later that the hospital that I was treated at doesn't accept Medi-Cal.
That's just horrifying!
I'm so sorry 🫂
The golden rule: “Those who have the gold, make the rules.”
I work in pharmacy, this is extremely true. Sadly, patients will take it out on us. If I had a nickel everything I have to say we don't determine the copays or having to explain their insurance to them, I would never have to work again. "Drug not formulary." "Prior authorization required." "Pharmacy not contracted." " After first fill, must use mail order." Also having patients wanting us to "price match" their copays to their preferred pharmacy, like what? You have a cheaper copay at that preferred pharmacy because they probably paid your insurance a crap ton of money to make sure you use their pharmacies. Or like this case, they're the same company.
Yeah I absolutely hate Optum RX and I hate that the people I see who have it are mostly the elderly who are very clearly being taken advantage of.
Yes, it's the height of immorality! I'm elderly; I don't have that problem because I wouldn't touch a Medicare Advantage plan with a ten foot pole, as we used to say. I have original Medicare (plan F) and a supplemental policy with BCBS that covers everything that Medicare does not. I never see a bill or pay a co-pay or deductible and never have to fight with any insurance company or agency ever. it's all between the insurance companies and the providers.
All I ever pay is premiums and part D deductible and co-pays. I live on $2,000 a month with a paid-off house and car. I prioritize my health that averages a total of about $500 a month instead of many things like tithing, charity, gifts, cable, smart phone, new clothes, eating out, hair cuts, magazines, impulse purchases, etc. I just don't buy anything I don't actually need. It can be done.
slow deliveries, opting you in to keep buying again and again before you actually need
And their call center of obviously outsourced overseas when you call
I was also wondering how this man is still alive&well in light of all his incredibly illuminating videos clearly outlining how US debt building erm i mean "health care" actually functions.
Of course i wondered how George Carlin survived as long as he did given his proclivity for truth.
Hats off to you, DocGlauc, and the odds will *always* be in Jonathan's favour!
Thank you so much for posting this series. It’s such a “fun” way to expose our system and desperately needed. I could go on and on in rage but seriously just thank you so much.
" You do not make 200 billions a year with an oversight"
But if I as a physician send an Rx to pharmacy my wife works at as a pharmacist even if that was the patients choice and neither of us owns the pharmacy. We could be in trouble for self referral. Our system is beyond flawed thanks to Congress and Senate.
Reminds me of when AMR, the largest ambulance company in America, was able to propose a California proposition that allowed ambulance companies to waive EMS workers' off duty 15 min breaks and 30 min lunch breaks. They worded it in a way to appeal to the public, and it was voted in by the people. If you have enough money, you really do get to write the laws.
I love living in Australia. The Pharmaceutical Benefits Scheme keeps most medications covered to an affordable price, you can choose generic brands if you want and you can go to whatever pharmacy you choose.
And if you're on a Health Care card for whatever reason, meds are capped at an even further discounted rate.
I take multiple medications daily and the prices are between $9-19 with no concession card (and if I had one all meds cap at $6). I have a friend who takes the same med in USA and its $80... I don't think I'd risk going on holiday to America in case something happened and I needed to get a script there...
Unless they suddenly decide to charge extra for the 'name brand' - and not everything is covered by PBS/healthcare card cap.
That being said, we also have the Safety Net - if a healthcare card hold goes over $xxx paid on scripts, the subsequent scripts that you would normally pay $8- for, are 'free' til the end of the year.
Some years I reach the safety net, others I don't; but I have also noticed a creep in medications that suddenly aren't covered, even just costing $15- - that don't count towards safety net, and will continue to cost after you reach it ...
It's STILL a godsend compared to what the Americans have to endure 🤯
I truly despise PBMs. They're the HOA of the healthcare industry. They were well-intentioned in the beginning, but quickly became predatory.
The more I see, the more I feel seen. You are nailing this series!
Thank you for doing this series. So necessary and so depressing and angering.
Reminds me of the time the Urban Affairs Minister wanted the Mayor's permission to permit real-estate in the eco-sensitive wetlands bordering our city. The Mayor in turn wrote to the Environment Minister for his expert opinion, to which he said yes. So the Mayor permitted the Urban Affairs Minister to go ahead....
Fun Fact : All the 3 guys above were in fact the one-and-same-person !!
Where was this???
@@sarahaltizer2285leaving a comment here to hear where :)
@@christopherrogers303same, i want the tea spill!
@2-minutephysiatry605 The people want to know!! Lol Don’t leave us hanging!! 🥺
Kolkata (Calcutta), India@@sarahaltizer2285
Makes you want to cry because it’s all so true
CVS caremark denied chemo for my son with spinal cord tumors. I had to go to the media to get them to change their mind. My son is a huge fan and says the neurologist is spot on. He's 14.
I'm curious as to what Caremark's reasoning was for the denial. Was it the the specific type of chemo they were denying or just chemo in general? Best wishes for a successful recovery!!
The last line of this really summarises the entire series tbh.
The man speaks the truth!
My partner has BCBS and has taken Vyvanse for years, which they took off their 2023 formulary.
His doctor was able to get a PA through (after trying 4 times) and they "generously" brought it down from about $421 to $80
Now that the generic is out, we were hoping that there would be more coverage. But nope. They don't cover it AT ALL. He'd have to pay the same amount he was having to pay for the name brand before the PA went through.
Make it make sense. Can they even get kickbacks from something they took off their formulary?
They are greedy bastards. That's the only explanation. The US health care system is screwed, and health insurance companies are a blight on humanity. I hope your partner is doing well.
I'm so glad I live in the UK. I'm now so happy with paying just over £100 for all my meds for a year.
The NHS can't even manage the 60 million people in the UK, let alone 350 million in the US.
You are a god ! Simple. Your charisma, knowledge and impact are beyond understanding.
This one is so utterly distressing to me that I'm trying not to cry.
So angry that this is how things work- but I absolutely ❤ you for peeling back the layers of the fermenting onion of US healthcare
I swear to G*d, this video series needs more exposure. How can we get our politicians to watch these? How can we get 50 million views?
I have two versions of UHC... they 'heavily suggest' OptumRX and optum services, but I had never heard of them, and I never actually knew they were owned by UHC... but my UHC is medicare and medicaid and they can't restrict which pharmacies I use.
Of course the pharmacy benefit manager has a twirling handle bar mustache like an old timey villain. As someone who wants to work in a pharmacy setting it makes me sick knowing what I'll have to do and I hope to make a difference in patient care in the near future. Please raise awareness of our health crisis more!❤
I really hope this starts some kind of change in the US healthcare system.
Citizens United's repeal would help with this issue, too
It's so refreshing to know that after coming out of the doctors office feeling like it we were just rammed up the rear, that the system was built to actively increase the ramming. 😊
It’s so depressing how true so many of your skits are 😭
Jimothy, when you make enough money you get to write the laws ( and buy enough legislators to make sure they get passed).
Also, in case no one knew, but Optum aka UHC now owns Spectera Vision Benefits, a vision benefits carrier…..
I can’t watch any more of these without exploding in anger !
I would love to laugh at these, but being someone who has worked for a TPA and a medical billing company over the past 10 years, I know all of this is true.
Why are we just sitting back and taking this abuse? I can and do contact my representative and senators. I WILL contact them all about this, and link to this video. Thank you. You are providing a fantastic public service.
Useless politicians are paid out
Really loving this series...
Really good message in this video!
Funny thing is today UHC did a sneak change to its formulary and stopped covering diabetic test strips completely. When we called to ask if there is one covered, UHC said nope so have fun being a diabetic on Medicare.
Insurance companies are going to place a price on Dr G's head.
Seriously Dr G, you rock!
I just saw that United Health Care has acquired/is in the process of acquiring two of the largest home healthcare agencies in the US. Sigh.
i been learning more and more about the us and yeah that last part rings true enough money and you rule
Thank you ACA.
Could you please do a skit on the Pharmaceutical reps giving free lunch and dinner to doctors and residents for medication presentations?
And cruises...
Cruises def not legal any more. Compared to PBMs, pharma lunches seem like child’s play..
When I was a kid my house was full of pens and note pads with pharmaceutical names on them (mom was a RN). I was a new nurse myself when the “drug swag” rules changed in 2009 and banned them. Over the next couple years I saw the pen cups in the nurses station dwindle and then disappear entirely. In the staff room there was a melamine dinner plate advertising Lexapro and I took it home as a soon-to-be-vintage novelty. I had it for more than 10 years before it finally broke. #RIPLexaplate
The current rules:
PhRMA's latest guidelines, effective January 2009, prohibit non-educational and practice-related gifts such as pens but continue to permit company-sponsored meals, drug samples, and other
"educational"" gifts valued less than $100.
National Institutes of Health
This put my family's pharmacy out of business, being in a small town it was hard on the community. The only other nearest pharmacy was a walmart pharmacy 30min away. That being said we had such a loyal customer base many of them that could afford it chose not to run their insurance so they wouldnt put us out of business, unfortunately we only lasted one year after that.
Just gives me all the more reasons to pray I never get terribly sick.
Or go to Canada or Europe ?
@@sorban5352
Mexico is closer.
@@SamlSchulze1104 They have the best food there.
Comic, but also chilling. And rage inducing.
I was watching the episode from two days ago and this one and thinking "Geez, this kind of vertical integration has been illegal in the film industry for decades!" The film studios aren't allowed to own distribution companies or movie theaters. And then there it was: the very words "VERTICAL INTEGRATION" right in this vid! My jaw actually dropped.
Actually a few years ago the rule that film studios, distribution companies, and movie theatres can't be vertically integrated was rescinded. It hasn't led to any major market changes yet, but it did allow AMC to act as distributor for the Taylor Swift concert movie after the actual distributors only offered it time slots in 2024 and 2025, not this month like Taylor and her management wanted. AMC instead said yes, they could show it at the date they wanted and distribute it to other theatres, so now the only ones making money off what is most likely going to be rather successful (especially compared to the tiny budget concert movies tend to have) are the movie theatres and Swift.
@@seonor The idea that there might be one positive outcome doesn't change the fact that this was a monopolistic practice that had a massive stifling effect on the industry. It was crushingly oppressive to independent filmmakers, giving the major studios complete control over whether their films ever saw the light of day. It is shortsighted to think that the same thing won't happen again. Corporations have a way of treading lightly about such things, as none of them wants to be known for being the first to take such negative action, the likely explanation of the fact that there haven't been, as you noted, "any major market changes...YET." But once one does make use of the monopolistic power this provides them with, that opens the floodgates for them all to do so, too.
@@edmilham4172 Yes, of course it's a bad thing that the protections against monopolies are weakened or removed. I just thought it was mildly funny that it backfired in this one case.
And this is why a lot of independents will do cash price + dispensing fee. In the long run it’s cheaper for generics and no dir fees or clawbacks. Our governor here in KY I’d planning to change the pbms reimbursement for medicaid. Got to meet him a couple weeks ago.
Yup, vertical integration applies to Chile as well.
Health Insurance companies are mandated to guarantee access to treatment for a list of diseases (you could call that a silverlining I guess), but then they are allowed to control which hospitals (99% of the times, private) you are allowed to go to with their insurance, and then they force you to only buy the allowed medications (99% of the times, brand name) in your treatment from certain pharmacies (one of which is owned by...Walgreens)
I love all of your videos, without a doubt, but I feel like I've seen this one before. It's still a great video!
You made it all the way to the comments just to miss his about why he reposted it…
it's a set up for the next prepared video the following day.
@@DaTimmehIf you notice the comment times, I commented this before he posted that comment.
@@ItBePatYo yours was 2 minutes after his, but might not have loaded when you clicked on the video tbf
@@DaTimmeh No, mine said 1 minute before.
Your Sept series makes me feel like I’m watching a “True Crime” series. As one who’s experienced healthcare in Canada, Europe, and Australia, I have a chip on my shoulder every time I go to see a US doctor.
Oldy but a goldy.
LOVE THESE!!! So spot on. And the org chart was genius! 💜
Ah yes, the joy of living in an oligarchy - as long as you have money, you are set.
I'm a career counsellor outside the US (ie the civilised world), and I can help my clients find the best career for them, depending on their interests, abilities, all of that, with all the freedom in the world to decide. Had I been working in the US, my only advice to everyone would be ' make as much money you can in any way and screw your interests', and that terrifies me.
I love these videos. Low key, I hope one of these videos is about the Medicare Part D Late Enrollment Penalty because that penalty is total bullshit, lol 😝
Keep up the awesome work though. Your videos are always so informative and entertaining. 😄
I always wanted to work at a PBM, from the time I was a young boy, now I'm not so sure. Thanks Doc Glauc!!
Don’t do it. It is pure h3ll.
I feel like I seen this one, but it fits the topic damn well.
My favorite part was in 2019 when Optum sued into the ground a industry distupting non-profit competitor for executive non-competes, breaches of contract, and trade secret violations.
Ironically, I found this channel as I am recovering from retinal surgery in both eyes. Thanks for making me laugh hard!!
Script writer: Dr. Glauck how dark do you want the 30 days series to be?
Dr. Glauck: Yes😈😈😈😈😈😈😈😈
Have a sinking feeling we're going to have to start a go fund me for witness protection for Doctor G
At this point UHC is so profitable and integrated in too many parts of the healthcare system and have the resulting political influence to match that people speaking out against them don't actually matter much.
@@seonor That's the American spirit.
Literally the textbook definition of a vertical monopoly.
I’m so happy United hasn’t forced me into Optum Rx yet (despite not allowing me to use my local pharmacies)
I've been following the videos. They are very good, very funny and very informative. But, you said it would be a fundraiser and I can't find any fundraiser link. Where is that?
My husband has recently had this issue. He is prescribed a medication that they took of their formulary and we can't afford to pay out of pocket. :(
Brilliant
That last part is very sad but true.
Any way we can give Big Pharma the John Wick treatment? The more we keep learning, the more I either shocked or disgusted.
Gotta LOVE the chain of command! LOL 🤣
You are a genius.
Thank you. This was very informative...and depressing.
Can you do the next series of these showing how we can combat any of this?
This gets scarier everyday.
Terrifying
Yeah….. sounds right on every level.
Great video!
Was expecting him to say : oh we own a couple of senators has well when he was wasked what else he owns xD
I don't live in the US and I'm finding these videos so upsetting, I can't imagine what it must be like for US citizens
Can't wait for the day, when the Episode is 3 Minutes constant beeping, because Jimothy had finally enough...