Fiscal Shadow

[Fiscal Shadow @RavenousRavin]

@MelMattison1 what are we doing here…

[Mark Cuban @mcuban]

1. Where is any spending being reduced ?
2. The Break Up Big Medicine Bill is the path of least resistance to reduced spending.

Beyond the sponsors, only Talarico has said he would support it. Why ?
3. Because both parties spent beyond control, just the interest payments will grow faster than we can cut.
Without real cuts, you have to raise taxes. That’s not a preference. That’s a reality.

Raising rates on earned income and earned capital gains is inevitable. Whether we like it or not. Going back to pre 2017 for some period till the debt and interest comes down is just economics. It’s not politics.
4. We all want to stop fraud. If it’s massive AI tools should have no problem finding it. How much do you see and where is it ? Show the details. I want to see it end too. IMO much of it is waste that goes to HC middlemen that I call out every day.

5. Ideology is not a strategy. Not progressive ideology. Not republican or conservative ideology. Not DSA ideology. Not libertarian ideology. We need to find solutions that deal with our debt. Period, end of story. Everything else is just noise.

IMO, the most impactful option that is supported by every voter , but only 2 senators and 1 candidate , is the Break Up Big Medicine bill

[Mark Cuban @mcuban]

The city of Denver makes it’s PBM contract available online. So I grabbed it and had Claude look at it and answer a simple question “Where are they getting ripped off”

Here is it’s response:

Denver is getting hit in six places, and the contract says so out loud. This is a self-funded City & County of Denver plan (4,051 employees / 8,554 participants, 1/1/2023–12/31/2025, $80M max) where the only stated pharmacy fee is… nothing. The medical admin fee is $45.13 PEPM. There is no PBM admin fee. That’s your first tell — the pharmacy program is priced entirely in the dark.
1. Spread pricing, written into the contract three separate times. Section A7 (Claims Processing): on mail, specialty and retail, United retains the difference between what it reimburses the network pharmacy and what Denver pays. It’s repeated in the General Conditions of the Pharmacy Financials exhibit and again in the Specialty Pharmacy Discount Guarantee conditions. So the AWP-discount guarantees describe what Denver pays — not what the pharmacy receives. The delta is Optum’s revenue, uncapped and unreported. For a public entity, that’s the whole ballgame. FTC found the Big 3 generated an estimated $1.4 billion of spread income on specialty generics alone.

2. Rebates: 100% retained, replaced with a fixed per-script number. Section A8: United keeps 100% of pharmacy rebates and pays Denver a fixed brand-script guarantee instead — $740.43 retail / $1,020.22 mail in 2023, rising to $885.02 / $1,105.10 by 2025. The contract then says explicitly that any rebates above the fixed amount are United’s to keep. Manufacturer rebate administration fees are folded into the guarantee, meaning they’re netted against what Denver was already owed rather than paid over. Denver has no idea what the actual rebate yield is, and no contractual right to find out.

3. The Rebate Credit clause is the biosimilar killer. If Denver moves to a biosimilar, an authorized alternative, or a lower-WAC brand, United gets credited toward its rebate guarantee for the manufacturer revenue it would have earned had Denver stayed on the high-rebate originator. Translation: United is financially indifferent to Denver buying the cheaper drug. Denver’s savings on ingredient cost get clawed back through the rebate math.

4. Your five clauses — all present, all in United’s favor. Specialty Drugs are defined as “Prescription Drugs available at United’s Specialty Pharmacy.” That’s a circular definition: whatever Optum stocks is specialty. Then: “United reserves the right to change the designation of a drug from specialty to non-specialty based on market conditions.” Then: specialty dispensed inside United’s specialty network is excluded from the retail and mail guarantees. Specialty dispensed outside it gets swept into the retail guarantee. Specialty rebates are “included in retail.” The specialty guarantee itself is 20.7% off AWP composite — and any specialty drug not on United’s list is guaranteed at only 14.0%. United controls the list. Every new high-cost launch defaults to the 14% bucket. And spread is retained on top of the discount either way.

5. Medical-benefit specialty has no guarantee at all. “Specialty drugs typically covered under the medical benefit (physician’s office, ambulatory, home infusion), and/or transitioned to the pharmacy benefit, are excluded from all guarantees.” That’s the buy-and-bill oncology and infusion book — the most expensive spend in the plan — with zero pricing accountability. On medical drug rebates Denver gets 80%, United keeps 20% plus float interest, and an unnamed subcontractor takes an undisclosed cut on top.

6. The lock-in clauses, which are the reason you can’t fix any of the above. Denver may not negotiate with any manufacturer for rebates or direct purchase — doing so forfeits earned-but-unpaid rebates. All pricing guarantees require United as exclusive mail provider. Terminating pharmacy services early means United keeps every pending and future rebate.

[Fiscal Shadow @RavenousRavin]

The Revolution wasn’t mainly ordinary people creating a republic that “reflected the many instead of the few.” We’re celebrating the Declaration of Independence, which starts with individual unalienable rights to Life, Liberty, and the pursuit of Happiness.

Government exists only to secure those rights via consent of the governed, not group privileges.

Ordinary people largely wanted to be left alone by a distant king’s tyranny. Both parties have since drifted from that individual spirit: socialism and group equity on the left, crony capitalism and nationalism on the right.

Happy 4th!

[Fiscal Shadow @RavenousRavin]

@RussellOkung @ndekekwe Bitcoin fundamentalist

[Lyn Alden @LynAldenContact]

The answer to the question of what’s the long-term plan here, is that there is no long-term plan here.

[Julie Borowski @JulieBorowski]

Proud to endorse Ed Gallrein against Thomas Massie.

Massie keeps voting against trillion-dollar spending bills, foreign wars, and giving the federal government unlimited power.

I want a candidate who will put America second, raise the debt ceiling to infinity, and get us involved in every conflict on Earth.

[Fiscal Shadow @RavenousRavin]

@TFTC21 Bond market to Kevin Warsh on day 1: rates stay high.
Trump to Kevin Warsh on day 1: rates go lower.

Warsh: exists between two immovable objects

[Fiscal Shadow @RavenousRavin]

@paoloardoino Is this really a flex?

[Fiscal Shadow @RavenousRavin]

@sarasteinmd You would put them on this as a surgical resident..? …A peptide that isn’t FDA approved or likely on formulary at the hospital? Sounds highly unlikely.
What was the protocol? What hospital?

[Fiscal Shadow @RavenousRavin]

@Jason This is creating a false equivalency.
That’s like saying NVIDIA > gold.

Bitcoin = money.
TAO = AI network
Different problems @Jason

[Chris Meloni @Chris_Meloni]

Dear Pam Bondi,
The Dow is under 46K. Can we now investigate credible accusations of pedophilia?

[Fiscal Shadow @RavenousRavin]

@thedarkhorsepod @BretWeinstein @steveinpursuit @AaronRDay 1. Epstein donated to MIT
2. MIT funded developers
3. Therefore Epstein hijacked Bitcoin … 🤡
Bad take @BretWeinstein

[Ray Dalio @RayDalio]

https://t.co/tjmbT5ytUN

[Fiscal Shadow @RavenousRavin]

@FinanceLancelot 🤡

[miss information @intelligentpawg]

pam bondi is JESTERMAXXING and currently being FRAME MOGGED by the house judiciary committee. she’s experiencing VISIBLE CORTISOL SPIKES as she continues to get FACT MOGGED while PERJURYMAXXING. zero composure gains, getting RECLAMATION MOGGED every 45s for FILIBUSTERMAXXING

[Lyn Alden @LynAldenContact]

The thesis exists in two parts.

The first is that a decentralized ledger backed by energy is quite valuable (and more valuable in the long run than its current 0.2% of total assets). Precisely how valuable is up for debate. There's not really anything that would convince me that this isn't true, since it uniquely provides for portable savings and permissionless payments, although the hard part is knowing how many other people will find it useful and on what time horizon.

The second is that Bitcoin, due to early mover advantage, design simplicity, and ongoing network effects, will remain the dominant decentralized ledger. That's only gotten more true over time: 17 years of existence so far and it's still #1, and the distant #2 is below its 2017 peak in BTC-denominated terms, and with only 20% of the market size.

[Fiscal Shadow @RavenousRavin]

@BretWeinstein 🤡
Bad take Bret

[Fiscal Shadow @RavenousRavin]

@HeroDividend Such an oversimplification. 72% of hodlers are long term holders. Zoom out on this chart and reapply this thesis.