[ethbr1]

The biggest problem with the US health system? Complexity.

It's impossible to fix overly complex systems.

Simplify, simplify, simplify, and then the fixes become trivial.

In the US case, that means banning most of the middle-layers.

[zdragnar]

Alas, independent middle layers have long been the US solution to avoiding monopolies. This is the whole reason car manufacturers can't sell directly to consumers, and micro breweries can't sell to consumers except for on-site purchases. Breweries in particular have to sell to distributors, who sell to stores.

Banning the middle layers here (absent other changes) just means that the companies that replace their spots in the top 20 will be vertically integrated conglomerates that manufacturer, distribute, prescribe and provide insurance (i.e. payment plans) for pharmaceutical drugs.

[vitus]

> Banning the middle layers here (absent other changes) just means that the companies that replace their spots in the top 20 will be vertically integrated conglomerates that manufacturer, distribute, prescribe and provide insurance (i.e. payment plans) for pharmaceutical drugs.

Except these companies are already vertically integrated, to a large degree. All the biggest insurers have their own in-house PBMs.

CVS (the parent company of Aetna) has Caremark.

Cigna has Express Scripts.

Anthem (fine, Elevance) has CarelonRx.

UnitedHealth Group has Optum.

[potato3732842]

I'll take a monopoly I can afford over a ton of entrenched middle men that I can't