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Who exactly is going to cut their prices ? Independent physicians can barely pay their bills. DPC is already a bargain. Hospitals are going to get rid of facility fees or walk away from keeping 340b margins and passing that to the patient ? No.
Big PBMs are going to stop charging fees ? No. Big insurers are going to stop gaming vertical integration transfers ? No
Break up the big insurance companies first. Make them divest each vertical , PBMs, Providers, ASOs , Digital They are the ATT1984 of 2026.
Break them up.
They have become Too Big To Care
Last quarter I rolled out Microsoft Copilot to 4,000 employees.
$30 per seat per month.
$1.4 million annually.
I called it "digital transformation."
The board loved that phrase.
They approved it in eleven minutes.
No one asked what it would actually do.
Including me.
I told everyone it would "10x productivity."
That's not a real number.
But it sounds like one.
HR asked how we'd measure the 10x.
I said we'd "leverage analytics dashboards."
They stopped asking.
Three months later I checked the usage reports.
47 people had opened it.
12 had used it more than once.
One of them was me.
I used it to summarize an email I could have read in 30 seconds.
It took 45 seconds.
Plus the time it took to fix the hallucinations.
But I called it a "pilot success."
Success means the pilot didn't visibly fail.
The CFO asked about ROI.
I showed him a graph.
The graph went up and to the right.
It measured "AI enablement."
I made that metric up.
He nodded approvingly.
We're "AI-enabled" now.
I don't know what that means.
But it's in our investor deck.
A senior developer asked why we didn't use Claude or ChatGPT.
I said we needed "enterprise-grade security."
He asked what that meant.
I said "compliance."
He asked which compliance.
I said "all of them."
He looked skeptical.
I scheduled him for a "career development conversation."
He stopped asking questions.
Microsoft sent a case study team.
They wanted to feature us as a success story.
I told them we "saved 40,000 hours."
I calculated that number by multiplying employees by a number I made up.
They didn't verify it.
They never do.
Now we're on Microsoft's website.
"Global enterprise achieves 40,000 hours of productivity gains with Copilot."
The CEO shared it on LinkedIn.
He got 3,000 likes.
He's never used Copilot.
None of the executives have.
We have an exemption.
"Strategic focus requires minimal digital distraction."
I wrote that policy.
The licenses renew next month.
I'm requesting an expansion.
5,000 more seats.
We haven't used the first 4,000.
But this time we'll "drive adoption."
Adoption means mandatory training.
Training means a 45-minute webinar no one watches.
But completion will be tracked.
Completion is a metric.
Metrics go in dashboards.
Dashboards go in board presentations.
Board presentations get me promoted.
I'll be SVP by Q3.
I still don't know what Copilot does.
But I know what it's for.
It's for showing we're "investing in AI."
Investment means spending.
Spending means commitment.
Commitment means we're serious about the future.
The future is whatever I say it is.
As long as the graph goes up and to the right.
Talking to independent physicians, it's obvious that the big insurance carriers are doing to them, what their PBMs are doing to independent pharmacies.
They deny, underpay, slow pay, clawback, and create administrative mazes, knowing their victims don't have the time or resources to fight.
Why ? By putting financial pressures on physicians and pharmacies, it makes them more likely to sell their businesses to them , close their doors, or refer the business to their captive pharmacy or provider. All benefitting the biggest insurance companies
We need to ditch the concept of "claims" and make every delivery of medications or care as a billable event that must, by law, be paid on a timely basis , with interest charges for any delays. If the physician or pharmacy doesn't deliver , the carrier has plenty of legal options already. As does the patient.
This is not an efficient market. This is the big guy abusing the little guy. It needs to change to better the care we get in this country
"My name's Raymond. I'm 73. I work the parking lot at St. Joseph's Hospital. Minimum wage, orange vest, a whistle I barely use. Most people don't even look at me. I'm just the old man waving cars into spaces.
But I see everything.
Like the black sedan that circled the lot every morning at 6 a.m. for three weeks. Young man driving, grandmother in the passenger seat. Chemotherapy, I figured. He'd drop her at the entrance, then spend 20 minutes hunting for parking, missing her appointments.
One morning, I stopped him. "What time tomorrow?"
"6:15," he said, confused.
"Space A-7 will be empty. I'll save it."
He blinked. "You... you can do that?"
"I can now," I said.
Next morning, I stood in A-7, holding my ground as cars circled angrily. When his sedan pulled up, I moved. He rolled down his window, speechless. "Why?"
"Because she needs you in there with her," I said. "Not out here stressing."
He cried. Right there in the parking lot.
Word spread quietly. A father with a sick baby asked if I could help. A woman visiting her dying husband. I started arriving at 5 a.m., notebook in hand, tracking who needed what. Saved spots became sacred. People stopped honking. They waited. Because they knew someone else was fighting something bigger than traffic.
But here's what changed everything, A businessman in a Mercedes screamed at me one morning. "I'm not sick! I need that spot for a meeting!"
"Then walk," I said calmly. "That space is for someone whose hands are shaking too hard to grip a steering wheel."
He sped off, furious. But a woman behind him got out of her car and hugged me. "My son has leukemia," she sobbed. "Thank you for seeing us."
The hospital tried to stop me. "Liability issues," they said. But then families started writing letters. Dozens. "Raymond made the worst days bearable." "He gave us one less thing to break over."
Last month, they made it official. "Reserved Parking for Families in Crisis." Ten spots, marked with blue signs. And they asked me to manage it.
But the best part? A man I'd helped two years ago, his mother survived, came back. He's a carpenter. Built a small wooden box, mounted it by the reserved spaces. Inside? Prayer cards, tissues, breath mints, and a note,
"Take what you need. You're not alone. -Raymond & Friends"
People leave things now. Granola bars. Phone chargers. Yesterday, someone left a hand-knitted blanket.
I'm 73. I direct traffic in a hospital parking lot. But I've learned this: Healing doesn't just happen in operating rooms. Sometimes it starts in a parking space. When someone says, "I see your crisis. Let me carry this one small piece."
So pay attention. At the grocery checkout, the coffee line, wherever you are. Someone's drowning in the little things while fighting the big ones.
Hold a door. Save a spot. Carry the weight no one else sees.
It's not glamorous. But it's everything."
Let this story reach more hearts....
Credit: Mary Nelson
Hey @AmericanAir been in Charlotte for 7 hrs -1st plane we sat loaded for 2 hrs and could they not reset a sensor, unloaded got on second plane, they forgot to do a security screen and had to unload that plane and reload AGAIN! Are you this incompetent all the time or a one off
@TheDrugMoney Dropping off a refrigerator at a rental today myself. I’m kicking myself for not excluding refrigerators from leases. I bet I will from now on.
CVS Caremark and the other Fortune 20 pharmacy benefit managers are price-gouging patients and bullying independent pharmacists.
We’re going to keep holding their feet to the fire. #PharmacistsFightBackAct
@TheDrugMoney Congratulations! It’s terrifying and exhilarating all at once!! Once you adjust you look back and won’t know how you did it before. Enjoy the ride and trust the process!! Best wishes and keep us updated on the journey!!
@TheDrugMoney I’m ready to retire from this W-2 shit and work the rest of my life for myself. That’s not work in my opinion, that livin your life your way.