You have provided a link to an article in Forbes that discusses monopolization of medical care by private equity.

The article discusses at length opportunities for price gouging and anticompetitive practices.

What it does not discuss is the rampant fraud present in billing.

Physicians employed in emergency rooms run by private equity routinely co-sign notes written by physician extenders like PAs and APRNs. Medicare reimburses APRNs at 85% of the physician rate. But when a physician co-signs the note, the reimbursement is at the physician level.

Physicians who fail to sign these notes are not called back for shifts.

These physicians tell you that they are paid very well by their private equity employers. But the revenue generated by these fraudulent practices are several fold higher.

Physicians also take tremendous liability when they sign these notes as they have not truly participated in the care of such patients.

But when private equity monopolizes distribution of shifts to physicians, I can see this could easily happen.

OIG audits can easily pick up such aberrant behavior.

And while fines can be levied, they are just the cost of continuing business. Disbarment is not easy as every hospital department run by private equity is probably registered as a separate LLC. These can be easily formed again.

The answer probably lies in preventing non-physicians from owning or directing such businesses. This should be extended to hospitals and insurance companies as well as their model to make money is not much different

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I figure out that the real job creators in this country are us, the little employed people. The insurance companies create all these layers of shadow companies like the PBMs, and companies that “manage” you health plan decisions, questioning the treatment plans your physician made with you, pushing other services that you might not need or not be interested in. When you have a complaint, you are taking from one intermediary to another until you give up. Each intermediary has a bunch of C-suites, paper pushers, all sucking up our money under the disguise of “freedom of choice” that we should have with private insurance. We are creating all these jobs that had no reason to exist. We are the actual job creators.

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Mar 1Liked by Matt Stoller

epic news! and Great reporting, thanks Matt

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Well, hopefully we didn’t allow tax paying dollars to subsidize the cost of insulin so that Americans think they are getting a good deal, while the drug companies get subsidized for a higher direct cost from the fed.

Remember, the ACA was originally suppose to use tax dollars to subsidize the cost to publicly traded insurance companies for picking up the “pre existing” conditions.

Somehow I really doubt they did this out if the goodness of their hearts without getting something under the table.

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Enough hate from the general public, spearheaded by Lina Khan, seem to be making some big changes... 💖💖💖💖

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A bit of welcome good news but unlikely more than a calculated marketing ploy by Lilly. They are most likely jealous of all the obscene profits reaped by Pfizer with their ‘vaccine’ fraud. It will take a lot more than reducing some insulin prices to fix what’s wrong with our entire medical/ pharmaceutical/ regulatory industry and all their bought and paid for DC political cronies.

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Did Lina Khan just lower the prices of insulin? This question reminds me of the old saying which goes something like, "Success has many parents, but failure is an orphan." In light of the complexity of the insulin market and the multiple events going on simultaneously, there's no simple, ironclad way to prove cause-and-effect. But Lina has as good a claim as anyone to causing the lower prices. Maybe even the best claim. At a minimum she helped.

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I'm really surprised that it's only 8 million. I thought that number was 10 times higher based on how much conversation / awareness there is about it, and also how many people I personally know who have it, or have passed away from it (a friend who was just 49).

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Saw the USA Today article on this posted in Reddit: it reads like a news release from Lilly, even quotes Lilly Chair and CEO David Ricks asking others to join him in this humble public service: “We are calling on policymakers,employers and others to join us in making insulin more affordable.” (Can you say ‘selfless patrician’?)

No mention of Lina Kahn, no mention of the House Democrats on the Oversight Committee-though it mentions but doesn’t explain the structural cost-inflation history of PBMs, it gives Senator Sen. Chuck Grassley the platform:

“middlemen known as pharmacy benefit managers created a ‘vicious cycle of price increases that have sent costs for patients and taxpayers through the roof.’”

Love the way our news system makes such rich mud of stories in order to hide the footprints of their masters. It makes Big so unique, more so because you’re developing a bi-partisan, historically contextualized narrative!


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Mar 2·edited Mar 2

This is such great news!

As you told me in a comment response a number of years ago, "The insulin cartel is the worst".

I'm cautiously optimistic that competitive pressure will force Sanofi and Novo Nordisk to follow suit. Interestingly, on the day of the announcement, Eli Lilly's stock was up contrary to the larger market. Investors didn't seem to react strongly to the news.

At the risk of spending to much time on a soapbox...

One small correction that doesn't impact the larger story you're reporting here: the 1922 innovation that led to a Nobel prize in medicine wasn't for creating artificial insulin. It was for discovering that lack of insulin caused the complications/death in diabetics and for creating a process from which pig/equine/bovine insulin could be extracted and refined from said animal pancreases to safely treat diabetes.

The newer genetically engineered insulins didn't really come about until the 1980s when Eli Lilly leveraged and commercialized the government's research and breakthroughs (namely recombinant RNA technology) that allowed for genes to be spliced into other organisms. In this case, the human genes that enable our body to produce it's own insulin were spliced into e-coli bacteria to enable the bacteria to produce human insulin. Since then, the artificially (although genetically similar to human, called analogues) produced insulins have been tweaked through further genetic modifications and additives to allow them to work better: faster or slower, with defined peaks or plateaus in strength etc.

Last point to bring up. There are two primary types of diabetes: Type 1 and Type 2. Type 1 is an autoimmune disorder. All type 1 diabetics need externally injected insulin to survive. Type 2 is a metabolic disorder. Type 2 is far more common but not all type 2 diabetics need external insulin to treat the condition, hence the discrepancy in total number of diabetics and number needing pharmaceutical insulin. Given that type one diabetics need the insulin at all costs, they are the perfect example of a captive market.

To non-diabetics, all insulins sound the same, but the quality of life differences between the cheap early-80s insulin sold by walmart versus the stuff brought to market in the 90s until now are vast. There's absolutely no reason that Humalog, originally brought to market at $26/vial under patent protection in 1996 should have cost $85-100 a vial in 2023.

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Of course, my first thought was, insulin ought to be free; we should have a nationalized capacity to produce crucial, life saving drugs and treatments. Look at the FDA shortage list sometime; prior to the Pandemic a group of hospital chains were setting up their own manufacturing capacity to deal with shortages in some critical drugs.

Nonetheless, this is good news, and will without a doubt save some lives. Success begets success, it shows some of these fights are winnable and worth fighting. (And losing begets learning.)

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