Uncovering the Hidden Influencers of Our Health System

Alex Yarijanian: 00:00:00

So healthcare, right. It's like, I don't even know where to begin. This is some giant confusing thing we all have to deal with.

Odin Contreras: 00:00:06

It really is. And today we're going to try to make a little more sense of it maybe.

Alex Yarijanian: 00:00:12

Yeah, like, are we just totally getting scammed? That's what we're asking today.

Odin Contreras: 00:00:17

And we're going to use some help from More Perfect Union, the investigative journalism outlet.

Alex Yarijanian: 00:00:23

They do some great work, don't they? They really pull back the curtain on stuff that's, you know, maybe not working as well as it should.

So in this case, they're looking at the American healthcare system and they're like, this is just a giant scam.

Odin Contreras: 00:00:37

They go into a whole bunch of different examples, such as big pharma IV bags, like the ones you see in the hospital.

Alex Yarijanian: 00:00:44

Get ready to be, I don't know, like shocked, a little bit angry, maybe laugh a little because it's just so ridiculous. It's good for you to laugh about it. Let's start with something that a lot of people are dealing with right now. Medicare Advantage.

Have you heard of this? Your parents, maybe?

Odin Contreras: 00:01:01

I have, actually.

Alex Yarijanian: 00:01:02

It's, it's everywhere, right? All those ads, like it's the cheaper, better way to Medicare.

Odin Contreras: 00:01:08

Right. But is it really? That's what More Perfect Union is looking into.

They think it's more about companies making a ton of money than it is about actually taking care of people. And specifically at this company, CVS Caremark, a giant pharmacy company.

Alex Yarijanian: 00:01:23

Yeah, they are everywhere.

Odin Contreras: 00:01:26

The Biden administration started cracking down on fraud within the system. And guess what happened? CVS's profits took a big hit.

Alex Yarijanian: 00:01:34

That's interesting.

Odin Contreras: 00:01:35

Very interesting. Maybe a little too interesting. So it's like they were betting on a system that only works if you bend the rules a little bit.

And speaking of cvs, let's zoom in on what's going on inside their actual stores. Picture this. You're a pharmacist, right? You're totally stressed out, totally overworked, and you're like, I'm afraid I'm going to kill someone.

Because you're so overworked.

Alex Yarijanian: 00:01:58

Oh, yeah. And that's not a made up scenario. That's for More Perfect Union.

They found that this is a real problem, that pharmacists at CVS are under so much pressure, they're worried about making mistakes.

Odin Contreras: 00:02:14

That's scary, right?

Alex Yarijanian: 00:02:15

An irony. CVS is like this mega healthcare company, but their own employees are often struggling to afford health care.

Some of them are even on public assistance. It's like Walmart, the richest company, but everyone's on welfare.

Odin Contreras: 00:02:28

Wow.

Alex Yarijanian: 00:02:30

It's like they can't even take care of their own people. What does that say about the whole system?

Odin Contreras: 00:02:35

Okay, ready for a curveball. Remember a hurricane, Helen, right?

Alex Yarijanian: 00:02:40

Yeah. 24.

Odin Contreras: 00:02:41

Well, it causes nationwide shortage of IV bags. Turns out almost all of them from one company, Baxter International. And the hurricane hit their frame main facility.

Andrea Garcia, JD, MPH: 00:02:51

Well, the threat of a long term shortage did prompt the administration to invoke the Defense Production act to help speed up recovery efforts and get that North Cove plant back up and running. In addition to canceling or postponing elective surgical procedures.

You know, Hoffman hospitals are also turning to alternatives for hydration like hydration tablets and Gatorade. And they're prioritizing IV fluids for the most acute patients and the most vulnerable, like children.

Some hospitals are even beginning to produce their own solutions. The FDA did release new guidance that eases up on rules regarding the compounding of IV solutions.

And that's to make it easier for hospitals and other facilities to do this during the the shortage period.

Odin Contreras: 00:03:44

So suddenly hospitals are all over looking like crap, like we need IV bags. It's like finding out your whole city relies on one grocery store for milk and it's just closed down.

Alex Yarijanian: 00:03:55

Wow. You know, actually I heard about that IV shortage. That's exactly the point More Perfect Union is making.

When one company has that much control over something that's so important, it's a recipe for disaster. Like what if you're in the hospital and you need an iv? It's not about inconvenience. It's about life and death. Right? Let's talk medications.

We've all heard about oic, right? And this weight loss drug, miracle drug, does all kinds of other things. It's featured on Berlin Catwalks. It could be a huge fight against obesity.

But there is a catch. It's super expensive in the United States, like $936. And in other countries, a tenth of that price.

Odin Contreras: 00:04:43

Wow, that is something.

Alex Yarijanian: 00:04:45

So this is a miracle cure or are we just getting ripped off?

Odin Contreras: 00:04:50

Makes you wonder, if this drug is already so expensive, what does it mean for the future of healthcare costs? Is anything going to be affordable?

Alex Yarijanian: 00:04:59

Right. Is it? And speaking of things that are maybe not so good for us, let's talk about sugar. Everyone loves a little something sweet. I do.

But did you ever think about how Sweet Tooth was created?

Odin Contreras: 00:05:16

Not really. When I'm eating a delicious pint of ice cream.

Alex Yarijanian: 00:05:18

Yes, the Talenti ice cream. Not sponsored. Well, more Perfect Union. I keep Saying More Perfect Union because I want these guys to get all the credit they can. Looked into this.

They found that the Sugar association, there's a thing. The Sugar association, the industry group for sugar, has spent decades trying to downplay how bad sugar is for us.

They even paid scientists to say that fat and cholesterol were the real problem when it comes to heart disease. It's like finding out your favorite movie was actually directed by a super villain.

Odin Contreras: 00:05:51

Wow. It makes you think how much of what we believe about food is actually true and how much of it is just marketing.

Alex Yarijanian: 00:05:58

Exactly right. Because one day eggs are bad, the next day they're suddenly on a good list.

One day coffee is going to kill you, the next day it's actually good if you don't put any sugar in. It all helps your Alzheimer's. It gets even crazier. You know lunchables, right?

Odin Contreras: 00:06:11

Oh yeah, those little snack packs.

Alex Yarijanian: 00:06:12

Yeah.

More Perfect Union found that they had lead in them and Craft, the company that makes them kept selling them to schools for that national school lunch program even after they knew about the lead. Hey, took a massive public outcry, like 50 plus thousand petitions to finally get pulled. It's like how do you even find out that there's lead?

And then how do you even galvanize all these people to go and do a petition? I mean these are by definition lower socioeconomic. Impoverished people were getting free lunches, right?

Odin Contreras: 00:06:44

Absolutely. It's so terrible that they prioritize profits over kids health like that.

Alex Yarijanian: 00:06:50

Are we surprised? I guess we can act surprised. Oh, it's pretty messed up. But then we got big pharma, so now the sugar looks like nothing.

And the big pharma is waiting to help us get, get better from all the sugar. Who can we trust? Big pharma, Sugar, Lead. And there's another player in all of this.

Most ad lib moment, another player in all of this that most people don't even want to know about or don't know about. And if they do, they don't want to know about.

Sen. James Lankford (Ok-R): 00:07:23

Let me say that again. McKinsey's biggest money earner is our health care system. And it's also where they've done some of the most damage.

In: 2018

Alex Yarijanian: 00:07:39

Providence Hospital is a tax exempt hospital. They're required to provide free care to poor people, people. And they were looking for any way to cut costs.

McKinsey and Company, I mean many who Are listening to this, are going to be shocked that McKinsey and company is coming up on this podcast as a hidden influencer.

Sen. James Lankford (Ok-R): 00:07:58

Ultimately, we need to untangle the dependency on consulting McKinsey has fostered in our government.

Alex Yarijanian: 00:08:03

Things are set up in such a way where if you just like cut.

Odin Contreras: 00:08:06

Off the consulting firms, I don't think you can build up that capacity overnight.

Alex Yarijanian: 00:08:11

They're like this super powerful consulting firm. Right. People clamor to get a role at McKinsey & Co. And work their fingers to the bone. And they do have a prestigious portfolio.

It's like the Deloitte of consulting in healthcare, kind of a little bit more niche. They advise pretty much every major industry, including health care.

Odin Contreras: 00:08:30

Really? Yeah. I've never heard of them, actually.

Alex Yarijanian: 00:08:33

Yeah, they're kind of behind the scenes. The reporting from the investigative journalists where we're following that, they're part of the problem.

They basically tell companies to make as much money as possible, which, I mean, you know, to their defense, if you're getting hired to consult, you're probably getting hired to consult to try to increase revenues, not decrease them.

But they tell these companies how to make as much money as possible, even if it means cutting corners on safety, which I have a problem with treating their employers badly and charging consumers more.

Odin Contreras: 00:09:07

Wow, that's really terrible. And it's almost like they're the masterminds behind all the scams.

Alex Yarijanian: 00:09:12

Yes. And the legal counsel of the show does want us to point out that we are following the reporting from More Perfect union. As to McKinsey & Co.

And their behind the scenes influence, they are pretty much part of the problem because they perpetuate this money making craze in healthcare and they're almost like the puppet masters pulling strings. If I could get visual with you, it's not just healthcare. They're everywhere.

But okay, let's stick with healthcare for now because healthcare is a touchy and important issue. What happens when you need to go to the emergency room? You know you're having an emergency, you're freaking out.

Well, increasingly those emergency rooms are being taken over by something called private equity firms. Private equity firms. And these are essentially large buckets of money.

They're not venture capitalists because venture capitalists typically invest earlier on. Private equity comes in and provides, quote, growth capital. They have all kinds of nice ways of saying what they're doing.

More Perfect Union says that that's not good news for patients. Think about it. Your hot.

Your emergency room is owned by a firm that manages private equity, meaning longer wait times Higher bills and most likely worst care.

Odin Contreras: 00:10:38

And why is that?

Alex Yarijanian: 00:10:40

Well, because private equity firms, their whole thing is about making money. It's in the name private equity. So that they come in, they cut costs, they squeeze every penny out of the system, and guess who suffers?

It's like healthcare is becoming discino, where you're gambling with your health and your finances. And speaking of finances, we got to talk about prescription drug prices. They're insane in the USA right now.

Odin Contreras: 00:11:05

Yes, they're way outrageous, honestly.

Alex Yarijanian: 00:11:08

But do you know why? I don't role of pharmacy benefit managers. That's why. Well, part of the problem is these things called pharmacy benefit manager, pbm, damn it.

Something like this. So people could twist their tongues when they're talking about these middlemen in the drug supply chain.

Sen. James Lankford (Ok-R): 00:11:29

What do they do?

Ana Kasparian: 00:11:31

Yeah, that is one of the most common questions. Everyone says, what is a pbm? They've never heard of a pharmacy benefit manager.

And say, I've never talked to a pharmacy benefit manager is because they are the middleman. They're the one in between. They're between the drug companies, the insurance companies, the pharmacists and the patients.

They're facilitating the price negotiation, but they're actually the ones actually setting the formulary. They determine often if you get a generic drug, a biosimilar or a brand drug, what that cost is.

Alex Yarijanian: 00:11:58

And more. Perfect Union says they're basically running a legal bribery scheme that drives up prices for everyone.

Well, part of the problem is these things called pharmacy benefit managers, or PBMs. They sound innocent, but they're these middlemen in the drug supply chain. And more.

Perfect Union says they're basically running a legal bribery scheme that drives up prices for everyone. This whole tangled web, and it's hard to tell who's benefiting, who's getting screwed. It's probably by design, isn't it?

Odin Contreras: 00:12:28

It's like the more you learn about this stuff, the more confusing it gets.

Alex Yarijanian: 00:12:31

Exactly.

Odin Contreras: 00:12:32

Yeah. That's a whole nother issue.

Alex Yarijanian: 00:12:34

But okay, before we wrap up this part, we've got to talk about one final example of how the health system seems designed to just take all of our money and just take it away, not even give it back. So I want to talk about the case of. Let's. Let's both talk about the case of Kiturada and healthcare costs.

Key to Ruda, which is a cancer drug, costs an unbelievable $200,000.

Odin Contreras: 00:13:00

How could anyone afford that?

Alex Yarijanian: 00:13:01

That's the point. And here's the kicker. It was developed using taxpayer dollars. So we all help Pay for it. This is a classic story.

We all help pay for it and now we can't even afford it. The company that makes Kitruda Merck is basically profiting off a drug we all funded. And now my blood pressure is changing.

How many need Merck medication? And get this, the government could actually lower the price by taking back the patent. But they haven't. I wonder like who, who's benefit?

Someone's benefiting from it.

Odin Contreras: 00:13:33

Yeah, that's just. That's just so wrong that they're doing that.

Alex Yarijanian: 00:13:35

Honestly, it's a prime example of how the system seems to be rigged against us, the regular people. And we're not even that regular. At least we know some of this stuff, right? Those that don't know it all.

But hey, don't worry, it's not all doom and gloom. We're going to dive deeper into some of these issues and talk about what you could do to fight back. That's the only part that's not doom and gloom.

You can fight back.

Odin Contreras: 00:13:57

No, yeah, that would be great. Just to shed some light on this very, you know, morbid topics.

Alex Yarijanian: 00:14:03

Why? Because it's depressing Odin and me. I know, right? But stick with us. There is hope. We're first going to depress you and then give you hope.

Just like pharma. So we've uncovered some pretty shady stuff happening in healthcare. And we'll talk about healthcare.

I want to circle back to Medicare Advantage for a minute. You know that program that's supposed to be cheaper and better than traditional Medicare? I feel like there's something we're missing here.

Odin Contreras: 00:14:28

You're right. There's a lot more to the story. Remember how More Perfect Union pointed out that Medicare Advantage plus seems to attract healthier patients?

That's no accident.

These companies have figured out how to cherry pick the people who are less likely to need expensive care, leaving traditional Medicare to cover the folks with more complex medical needs.

Alex Yarijanian: 00:14:46

I love your word choice cherry pick because this reminds me of an actual ban on cherry picking quotes, which is a thing where not too long ago Medicare Advantage plans would set up their Medicare 101 sessions to entice these patients to enroll in their insurance companies. And that would select second floor of a two or more story building without an elevator.

So if the patients couldn't get up there, then they were not healthy enough. Oh, to be. Yeah.

So essentially they were cherry picking by choosing spaces that disabled people who presumably cost more could not access anyway to reach their marketing material. So it's kind of like an insurance Company setting up a buffet and only inviting the people who eat salad.

Odin Contreras: 00:15:35

Ah. And they make it even more enticing with all those extra perks and benefits. A lot of these perks might not actually be worth it in the long run.

It's all about making Medicare Advantage look more attractive, even if it means leaving the most vulnerable person behind.

Alex Yarijanian: 00:15:51

I mean, if you notice those Medicare Advantage ads, they literally have like the Medicare eagle, which isn't even a thing. I think it's like on your original Medicare card, there's like a little eagle or something.

They make it look all official, you know, like this is coming. They, they put all the senior citizens favorite people on and it's all about. All about leaving the vulnerable people behind.

Because those Advantage plans, Medicare Advantage companies don't want you to utilize their services. Right. That makes the whole CVS situation even more suspicious.

When the government cracked down on fraud in Medicare Advantage, CVS wasn't very happy about it. Realized CVS has only been in the insurance business for just a number of small number of years. I mean, they were.

They bought Aetna and suddenly cvs, Aetna is in Medicare Advantage. Seems like their whole business model relied on this system that wasn't exactly playing by the rules.

Odin Contreras: 00:16:46

And that brings us back to the core issue. The healthcare system is designed to prioritize profit over people.

Whether it's insurance companies, pharmaceutical companies who seem innocent, like lunchbox snacks, even the focus seems to be on making money. Even it comes at the expense of.

Alex Yarijanian: 00:17:04

Our health or glamorous like MacKenzie and company. Speaking of which, let's go back to the IV bag shortage caused by Hurricane Helene.

It's crazy to think that one company, Baxter International, had so much control over something as basic as IV bags. It's like they were holding the entire health system hostage. People at hospitals had to ration IV bags. It was like a big thing.

Odin Contreras: 00:17:29

Oh, wow.

Alex Yarijanian: 00:17:29

I bet you didn't see that on PITS or House MD or whichever medical trauma people are watching more.

Odin Contreras: 00:17:35

Perfect Union found out that Baxter has a bit of a reputation for doing that kind of thing. They've been accused of price gouging in the past, taking advantage of their dominant position to inflate prices.

So it's not just about the hurricane. It's about a company that seems to prioritize profits over patients.

Alex Yarijanian: 00:17:52

Reporting highlights how lobbying and political influence play a huge role in shaping the healthcare industry. It's pretty simple if you think about it. You send a nice lobbyist or few up to Washington, day wine and dine, it's simple.

The incentives align very quickly. We are talking about millions of dollars. Not. That's an underestimation.

Billions of dollars spent to influence politicians and block regulations that might threaten corporate profits.

Sen. James Lankford (Ok-R): 00:18:20

UnitedHealth Group's chief executive bragged about how the Biden administration's ineffectiveness in cracking down on over billing in Medicare Advantage has led to record profits.

So the CEO Andrew Witty, told investors that he appreciates the White House's decision to slow the implementation of its Medicare Advantage reforms, which would prevent companies like UnitedHealth from potentially over billing and stealing from United States taxpayers.

Odin Contreras: 00:18:52

It's a giant game of chess. But the average person isn't even allowed on the board. We're just playing pawns in a system designed to benefit the powerful and the wealthy.

Alex Yarijanian: 00:19:02

Yes. Not even allowed to play on the board.

Odin Contreras: 00:19:06

Crazy.

Alex Yarijanian: 00:19:07

Which brings us back to McKenzie and co, those behind the scene consultants who seem to be whispering in the ears of everyone in power. What are you whispering? What exactly are you doing that's so shady?

Odin Contreras: 00:19:19

Yeah, and the article describes them as an ultimate profit whisperers.

They advise companies on how to squeeze every last dollar out of the system, even if it means cutting corners, exploiting workers and driving up prices for customers.

Alex Yarijanian: 00:19:33

It's like they figured out the secret formula for corporate greed and they're selling it to the highest bidder.

Odin Contreras: 00:19:40

And the scary part is that they operate in the shadows. Most people have no idea who they are or the extent of their influence.

They're like the puppet masters behind the curtain shaping the entire healthcare landscape to benefit a select few.

Alex Yarijanian: 00:19:55

As I continue to publicly disqualify myself from ever working with McKenzie, it makes you wonder if there's anyone looking out for the interest of patients and everyday people in this whole mess.

Odin Contreras: 00:20:06

That's why it's important to be aware what's going on and to speak up honestly. We just can't let corporations dictate how our healthcare system operates.

Alex Yarijanian: 00:20:15

You know, being aware is one thing. Speaking up is another. Doing those two things at once is yet a completely different other aspect.

Now, if you're employed by one of these corporations or if you have reasons to be concerned of retribution or retaliation, you're going to sit there very quietly and not speak, even if you're aware. So the question here is, what can we actually do? It feels like we're against these giant powerful forces that don't want us at the board.

Odin Contreras: 00:20:48

Exactly. Remember that even small actions can honestly make a difference. Isn't just about exposing problems. It's about empowering people to take Action.

Alex Yarijanian: 00:20:57

Well, now I'm so empowered I could barely stand. And what are some practical things our listeners can do to fight back against this massive depressive different formation we've shared with them?

Odin Contreras: 00:21:10

I'm glad you asked. First, let's stay informed. Keep learning about these issues, not just from perfect union, but from other sources too.

The more you understand how the system works, the better equipped you'll be to advocate for change.

Alex Yarijanian: 00:21:24

That sounds like a lot of energy. So knowledge is power, but what about actually doing something?

Odin Contreras: 00:21:33

Well, what are the most powerful tools you have? Get ready for this is your voice. Contact your elected officials.

Let them know you care about healthcare reform and that you want them to support policies that benefit patients, not just corporations.

Alex Yarijanian: 00:21:49

People underestimate how much power a phone call or email to a rep can have.

Now, as I, as I, as I admittedly read that part of the script, I mean, after minutes and minutes and minutes of saying the world's biggest companies and the consultants are all out to get you, we're telling people how much a phone call or email to a rep can have. It's like that old saying, the squeaky wheel gets the grease. That gives me hope because it's true.

If enough people make noise, our elected officials will have to listen.

Odin Contreras: 00:22:20

Exactly. And you also look for opportunities to get involved in your community. Are there local organizations fighting for healthcare justice?

There probably are. You can volunteer your time, donate if you can, or simply spread the word.

Alex Yarijanian: 00:22:34

You know what I want to do, Odin?

Actually, since we're talking about calling elected officials, we should bring out and expose folks from both parties who have conspired to bring us to this point where we cannot afford anything, really. And everywhere you turn, there's some conspiracy, some Wall street conspiracy.

Whether It's CVS or McKenzie or whatever, both sides have had this issue exasperated. So, elected official, no, no, it's not the other side. It's the ones that you voted for. It's the ones that I voted for.

I mean, it's kind of hard because you only have so many choices. And they're all conspiring. Why? Because as Odin said earlier, they're sitting there with lobbyists at beautiful steakhouses, at these dinners.

There's all this conspiracy going on. And think about the cost of the conspiracy versus the gain of the prophet. It's monumental. Monumental, Absolutely. Collective action is key there.

Strength in numbers. Persistence pays off sometimes. It really does. Persistence does pay off. It takes a village to take down a giant corporation.

Odin Contreras: 00:23:49

That's a great way to put it.

Alex Yarijanian: 00:23:51

And remember, community there has to be community.

Odin Contreras: 00:23:53

I mean, there's always Los Angeles in New York.

Alex Yarijanian: 00:23:56

Is there a community? And it's no longer in line with humanity.

Odin Contreras: 00:24:01

Yeah, it does come to the question sometimes, right? Like, are you willing to sell yourself out or are you willing to continue? You know, depends on the pricing. Depends on the pricing.

Alex Yarijanian: 00:24:11

Depends on the pricing.

Odin Contreras: 00:24:12

Yeah, you know, it's, it's tough. Especially whenever obviously some people have like these morals and want to keep going, but then, you know, they need to pay rent.

Alex Yarijanian: 00:24:23

There's a way to, to make your morals work. Like, you don't need to be immoral to make money in health care. Like, there is money already in healthcare to be made.

I guess maybe where these guys are, they're the big dogs.

They just suck money out of the system and make it generally available in healthcare for guys like us to go and, you know, say, okay, move a little bit of this here. Give it to the doctor, not the hospital. Move a little bit here, move a little bit there. Let's, let's keep that note then as we wrap up this.

We've spent all this time doing this deep dive using a lot of the reporting from More Perfect Union, follow their material. And we've seen through our own life experience some of this manifesting.

We've seen how corporations, the kind of that put profits ahead of people, have been just getting bigger and bigger and bigger and bigger. Now they're calling them too big to feel. Yeah, system seems kind of rigged, you know, it really does for the people with all the power and money.

The rest of us are kind of just like stuck paying for it all.

Odin Contreras: 00:25:37

So crazy, right?

Alex Yarijanian: 00:25:39

It really is. But I'm wondering, like, okay, what can we actually do about it?

Odin Contreras: 00:25:43

That's the question, right? You hear all this stuff, you're like, well, great, now what? But actually More Perfect Union, they just don't leave us hanging.

They give us some ideas, some actual.

Alex Yarijanian: 00:25:55

Steps we can take, including subscribing to this show, which doesn't exactly come from More Perfect Union, but I'm sure the sentiments aligned. Let's. So let's start with practical step number two, if that's step number one.

Odin Contreras: 00:26:07

So, yeah, so step number two is to always start with information, right? So you're already doing that, listening to this deep dive. The more that you understand, the better you can spot ways to fight back.

Alex Yarijanian: 00:26:18

Makes sense. But like information without action is also useless, you guys.

Odin Contreras: 00:26:22

Very true. So this is where your voice comes in. You have power. Remember that. You're just not a consumer in the system. You're a citizen.

So talk to your elected officials, all of them, local, state, federal.

Let them know that the health care reform that is important to you and tell them that you want to support policies that help patients, not just big companies.

Alex Yarijanian: 00:26:43

I think we have to innovate how we reach out to these elected officials.

Odin Contreras: 00:26:47

Just remember, you have power. You have. You might feel small, but you're not powerless. Your voice matters. What you do matters. And if we all work together, we can change this.

We can make healthc care better for everybody.

Alex Yarijanian: 00:26:58

And remember, you don't have to be an expert or a politician to make a difference. Stay informed, talk to people, speak up for what you believe in. Every little bit helps. And no, we're not asking for your money.

We're asking for your vigor, your energy that wraps up this deep dive into the healthcare system. Conspiracy, inspired and as exposed by more the guys at More Perfect Union. They're doing such important work.

So go check out their website and their material. And to all of those listeners out there, remember, you have the power to change things.

So stay curious, important, stay engaged, important, and stay hopeful. Most important.