David Barclay retweeted
This is an actual line from a peer-reviewed published paper in an IO journal, poo-poo’ing the idea of profit-driven inflation caused by a change in firm conduct (rather than an increase in demand) coming out of COVID. I’ll have more to say about this straw-man argument later, but if you have thoughts, please reply or write me.
David Barclay retweeted
New essay on “Lawless Antitrust,” out now in the @FordhamLRev. It unpacks a series of moves—action, inaction, judicial/admin opinions, and more—that flouted antitrust laws. It then explains why enforcers from '21-24 tried to put the “law” back in antitrust law. Short 🧵: (1/x)
David Barclay retweeted
This take continues to be increasingly correct
It's pretty clear that healthcare costs are going to go up in the near term with the introduction of AI
Three reasons for this. The first is simple - payers are being much more heavily scrutinized for their use of AI in preventing $ going out, while hospitals/companies using AI to bill more have a ton of leeway.
The second is that the current billing rails incentivizes AI use cases that are "add-on" billing line items. Consider the AI second reads of mammograms which are an up charge, the AI diabetic retinopathy screens that bill more than their human counterparts, etc. which are all effectively upcharges.
The third is that more people now have access to a self-diagnosing and triage tool, but also still need to go to the health system to resolve their issue if they need confirmatory labs, screening a prescription, etc. That's going to create more utilization inherently, though how much more than just using Google is TBD.
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Every time technology has been introduced into healthcare it's caused costs to be inflationary. My hope is that AI becomes a tool that makes costs deflationary, but there needs to be a clearer path for that to happen.
David Barclay retweeted
This reminds me of one of my favorite studies in healthcare.
A clinical team simply had the coders round with them in the hospital.
The profit per admission increased 42%. This was without changing a single part of their clinical care. Outcomes didn’t improve. They simply coded a higher intensity of care, leading to higher reimbursement.
Our system rewards coding more than it rewards care. The institutions that master the coding game are the ones that do the best.
David Barclay retweeted
Side note: If the US and Iran can literally sign a peace deal electronically why is it when you buy a house in the United States you have to pay thousands to some bullshit title company
David Barclay retweeted
Guys I think I know why health care costs are exploding
h/t @zackcooperYale
David Barclay retweeted
HHS OIG Report on prior auth and appeals denial rate by insurer - staggering numbers. Think of the burden created on providers, families, patients, the millions of house spent fighting medical necessity with payer bots.
David Barclay retweeted
The American healthcare system is an absolute fever dream. 🫠
Imagine going in for a routine, preventative screening that’s supposed to be 100% covered by law, and weeks later you get hit with a bill for over $3,000.
Here is exactly how the insurance companies “logic” you into bankruptcy:
1️⃣ The "Diagnostic" Trap: You have a screening colonoscopy because a prior test (like Cologuard) flagged a possible issue. Suddenly, your insurance decides it's no longer "preventative" but "diagnostic"—even though federal guidance explicitly says it should still be covered as a screening.
2️⃣ The Polyp Penalty: The literal point of a colonoscopy is to find and remove polyps before they turn into cancer. But the second the doctor actually does their job and removes one? Boom. Your procedure gets magically converted to "diagnostic" per your insurer's clinical guidelines, shifting the massive cost right back to you.
3️⃣ The Stealth Anesthesiologist: You did your homework, found an in-network facility, and an in-network doctor. But the anesthesiologist who walked into the room 90 seconds before you went under? Out of network. Apparently, they expect you to comparison shop while you’re lying on the table in a hospital gown.
4️⃣ The Surprise Facility Fee: You go to your regular GI’s independent outpatient center. But surprise! A massive hospital system recently bought out the practice. Nothing changed—same building, same doctor—but now you owe a hospital facility fee surcharge just because of a corporate acquisition.
It’s a rigged game designed to keep you guessing and keep you paying.
We got tired of the corporate insurance nightmare and the endless, unpredictable line items. That’s why we bypassed them completely to offer fair, transparent, and predictable pricing without the absolute headache.
David Barclay retweeted
PBMs DELAY PATIENT SAVINGS! First generics face slow adoption due to PBM & health plan coverage tactics—driven by brand drug rebates. Patients lose, even when lower-cost options exist. Learn more: accessiblemeds.org/resources… #GRxBiosimsSavingsReport
David Barclay retweeted
This is the shell game on the medical side. The same one runs on the pharmacy side: the PBM bills the plan, reimburses its own affiliated pharmacy at an inflated rate, and that inter-affiliate payment counts as “medical care” for MLR. Vertical integration didn’t break the 80% rule, it made every dollar of admin look like care. And MLR only applies to fully-insured plans anyway. Self-funded ERISA plans get no protection. The only audit is the contract.
David Barclay retweeted
Self-funded employers, before Q3, pull one number: what share of your specialty spend runs through a pharmacy your PBM owns. In most plans we see, it's the majority. That's not a network. It's a funnel.
David Barclay retweeted
When a PBM says "we pass through 100% of rebates," ask: 100% of what the PBM received, or 100% of what the manufacturer paid? Those are different numbers. A middleman sits between them.
David Barclay retweeted
I will believe AI is driving productivity gains in the old economy when a front desk person checks me into a hotel with less than fifteen hundred keystrokes and mouse clicks.
David Barclay retweeted
My annual heart transplant testing at @ClevelandClinic came back normal:
✅ Normal PET perfusion study
✅ No ischemia
✅ No scar tissue
✅ Normal heart function
✅ CAV 0
I've been on Everolimus for years, and @AnthemBCBS covered it until last year.
My transplant team does not want me to switch. Alternatives did not work for me, and changing medications now would be medically risky.
Despite that, @AnthemBCBS is demanding approximately $500 for a 30-day supply or $5,000 for a 90-day supply of the medication my transplant team says is medically necessary.
I've been fortunate to receive help from @mcuban (@costplusdrugs) and @warrisbokhari from @GetClaimable, but no transplant patient should have to rely on public attention to access a medication that helps protect a lifesaving organ transplant.
#HeartTransplant #PatientAdvocacy #Everolimus #OrganDonation
David Barclay retweeted
Davis Polk this week submitted $4.8 million in April-only billings to bankruptcy court overseeing Spirit Airlines case, including three 2nd yr associates charging $1,410/hr who together cost $725k:
document.epiq11.com/document…
David Barclay retweeted
Copay accumulators: a program that takes the manufacturer's copay assistance, keeps it off your member's deductible, and routes the value back to the PBM. It's probably in your contract. It's probably not labeled that clearly.
David Barclay retweeted
Pull a quarter of your plan's specialty claims. Sort by which pharmacy filled them. In most plans we audit, 60 to 80% ran through the PBM's own specialty pharmacy. That's not a network. It's a funnel.
David Barclay retweeted
Same generic drug. The retail pharmacy fills it for one price. The PBM's own mail-order pharmacy fills it for another. The PBM sets both prices. Guess which one it steers your members toward.
The active ingredient in a weekly Ozempic shot costs about 20 cents to make.
Not a typo. Andrew Hill’s team at the @LivUni tracked the real ingredient shipments and ran the numbers. A full year of generic semaglutide, packaged, taxed, profit built in, lands between $28 and $140. For the year.
Then the patent math kicks in.
@novonordisk Indian patent expired on March 20th. Within weeks, generics showed up at roughly $15 a month. Natco sells thirty days for 1,250 rupees, less than most people spend on coffee.
Americans can’t touch that price. The cash plan through Novo runs $349 a month ($199 to start), the list price tops $1,000, and US generics stay locked out until 2031.
Same molecule. Same 20 cents of ingredient. What you pay comes down to one thing: when the patent expires where you happen to live.


































