I see how to particpate

Website
21

This year was a big year for the Supreme Court. A lot of cases rolled in.
Here’s two rulings that impacted diabetics:

1.) Eli Lilly sues the government - Supreme Court won’t even hear the case. That’s a WIN for us. Supreme Court turns away Eli Lilly's challenge to whistleblower law - Maryland Daily Record

2.) This one is more nuianced and widley open to interpretation. In PBM reform, we saw the POTUS fire an FTC judge who was all finalized in her opinion and about about to rule in our favor against the PBMs. That was scary. Trump fires 2 Democrats on the Federal Trade Commission, seeking more control over regulators

The Supreme Court ruled in a scary way for us. We didn’t know, for sure, how newly appointed regulators would rule. People changed jobs a lot and it was hard to even GET judges at the FTC. They were short 2 judges FOR MONTHS. That made everything move super slow - painfully, extrutiatingly so. But eventually, the Executive branch and new agency judges ruled in our favor. That was a scary time when we were all coming unglued. I bothered Scott a lot trying to get information out of him about when something would happen. He wouldn’t respond, or he’d say he didn’t know, or he would drop scraps of information when he got them.

But what is more significant than that is that ANY courts will find in our favor on anything. I thought the courts were lost to us, until very recently. It used to be that courts ONLY ruled in favor of insurers. Members of state government would refuse to do their jobs, just for fear of getting sued by the insurance company. Maybe the State could settle, but they couldn’t afford to win in court against the insurers. They would sue over anything and it would eat up SO much time and money. At one point, c.2018, the insurers went to court with, like, ten states at once (I’ve never actually counted how many - a lot of) . Didn’t even break a sweat.

It was infuriating. The States asked the Feds for help…and they don’t do that very often. That is humiliating to states. https://www.naag.org/policy-letter/a-bipartisan-coalition-of-39-state-attorneys-general-urge-congressional-action-on-pharmacy-benefit-manager-reform/

It was really dark days of waiting for that Supreme Court ruling.

The athsmatics in wisconsin would post really sad songs, in reference to their dead children, like this https://www.youtube.com/watch?v=0-7IHOXkiV8. They did “go down,” really hard and kinda unfairly at a state level. I just kept telling them I was optimistic about things at the federal level. It’s all gonna work out there, now that there are rulings from the higher courts & in higher legislative bodies.

I was making veiled threats using this song: https://www.youtube.com/watch?v=y8OtzJtp-EM Sometimes I would make not very veiled threats.

The independent pharmacist lobby was posting Marylin Manson videos, which implies that they r enraged gen Xers.

Someone would have an emotional breakdown online every few weeks. I would just try and talk people down off a cliff and tell them it would all work out, but I had NO way of being sure. No one knew who the judges would be. It was really dark. Things get very high stress just before policy moves thru the meat grinder. This held up the process, right at the end, on something everyone had been working on for 20 years. It was dark. Emotions were highly unregulated.

In the end, it all worked out perfectly in our favor, though. It was a momentous win. Painful, but momentous.

1 Like
22

I’m glad you found the posts and realized there was a New tab. It’s frustrating when a small interface detail can make an entire forum seem inactive or unwelcoming.

1 Like
23

People talk about problems like that, but I can’t say that I have ever experienced it firsthand.

24

So, political partisans are texting me this morning. I don’t really understand anything about what they are venting about. It’s some complaint about integrity of their processes. They have a very deep breadth of knowledge about political processes. I don’t understand anything about it, but they are teaching me things. Honestly, it’s kinda meaningless me to me because these are state level guys. My goal, as a diabetic, is to own both parties - the way that the insurers have for years, so that policy comes out in my (our) favor. In many ways, it doesn’t matter to me WHO is elected, as long as I have political leverage higher up the chain. It’s like a chess game. Because we have political leverage over any particular political partisan or party, I know we are winning. Right now, I own both parties at both a state and federal level, as a diabetic. My policy objectives are moving. https://www.youtube.com/watch?v=rgc_LRjlbTU

They can move their pieces around however they want. It’s neither here no there to me. But I am everyones therapist in town. So, I listen to them vent. They listen to me vent when our federal processes are all seized up. It’s all fine. Political partisans are all worked up right now because their elections are coming. But to policy peeps, that doesn’t really matter because we have bipartisan support for our objectives. Both sides understand that they will be punished politically if they stand in our way - BOTH sides. Both sides contributed to this mess. They wouldn’t hear a word about it for years and years and years. Now they HAVE to fix it.

Now, we own the courts. We own EVERYTHING.

https://www.beckerspayer.com/payer/louisiana-sues-express-scripts-ascent-over-pbm-practices/

But we should have always had representation in the courts, as citizen. We didn’t because things were broken. It took a lot of effort to repair what was broken. There’s lots of work still underway.

What really matters in policy is that you tell the truth and you tell it authentically. That’s different than politics. Politics is kinda the opposite of that.

25

Here’s the guy that Michigan is sending to talk to me. @Boerenkool See minute 17.
He’s not Dutch, but my favorite lobbyist for the doctors is. They call him “Dutch.” That’s his nickname.

Michigan is full of Finnish immigrants and Minnesota is full of Swedish immigrants. This is what they could drum up.

They told me to read his book, but I only read half of it so far.

They want to help me fix problems. Policy work involves forming relationships with people who want to fix problems.

image
image618×137 8.24 KB

26

Darn. I spoke to a political partisan for a long time last night. For the first time, I kinda understood how what they were trying to do was similar to what we do. I was not mean to them. I asked some questions and kinda understood what they were talking about. They discussed a lack of integrity in processes. I was only able to understand because I put in time to learn and became farmiliar with terminology they used. I don’t know much, but I could follow what they were saying. It made sense. It kinda made me feel scared and a little sick. It made me feel like the risk of potential additional violence was not low. I did not like the conversation. I feel like this town is a box of kindling…still. It could go ablaze again. We had one patient die in police custody, which led the to the city burning several times over, we had an insurance executive killed, we had multiple state politicians shot and killed (plus, their dog), the feds came and more people died. I feel nervous about how the elections go down.

I feel like I am not doing a good job of communicating how much progress we are making and how we are making progress without needing to gun people down, which Americans are kinda prone to doing when they feel like they are being crushed by large powerful systems that they have no control over. It’s a cultural thing.

2 Likes
27

Cuban testified this week in your state. Mark Cuban Testifies to Texas Lawmakers About the Need for Adequate Dispensing Fees | American Pharmacies | 54 comments

He’s discussing aggressive practices in the market, where PBMs try to put all the small business, locally owned pharmacies (their competitors because CVS is BOTH a PBM and a pharmacy) out of business.

IF you assume Cuban is DFL (Democrat), but he is speaking the language of the GOP (Republicans), that is an effort to establish bipartisan consensus. When Trump works with Cuban, that is the same. That’s how you win - with sides on the same page.

When the administration changed, I told the independent (small biz) pharmacists that I didn’t want to hear anything other than arguments for small buisness, at least upfront. Why? Because we needed to shore up GOP support. Healthcare is not traditionally a topic that they have a lot of comfort with, but they understand that financial power and political power are one in the same.

Traditionally, the Americans who have the ability to fight with government and industry are small buisness owners. Why? Because when you work for someone else, they will just fire you. Small biz owners have a lot more agency. They control their own money, so they control their own voice. That’s why pharmacists have more leverage than doctors. They have more freedom of speech, as people who own their own biz.

Long ago, in many states, the insurers passed laws making it illegal for doctors to own hospitals. In my state, they can own clinics/practices, but the insurance company and the governement make that very difficult. How? By building HUGE administrative burdens on them, to the degree that MUST be a giant organization in order to overcome it. One example is Prior Authorization. My doctor tried to own his own endo clinic, but he went out of biz in 2 years because he couldn’t hire enough nurses to handle all the prior authorization requests being shot at him from the insurers. He effectivley couldn’t provide care. All he could do was fill out paperwork constantly. He couldn’t even do that. He couldn’t afford the staff to do that. So, he went to work for a large clinic/hospital system owned by my insurers.

The insurance company will immediatley fire a doctor who talks about PBM reform.

Does that make sense?

Dr Elizabeth Potter is in Texas. https://healthexec.com/topics/healthcare-management/legal-news/surgeon-sued-unitedhealth-over-social-media-post-says-shes-nearly-bankrupt

Potter owned her own biz. But when Dr Potter complained about insurance companies denying care to her patients, they kincked her out of network. So, none of her patients cold use their insurance policy at her clinic. That effectvley ruined her buisness.

So, Her choices were:

1.) Exercise her freedom of speech to promote ethical patient care (exercie her political freedom) AND as a result loose her financial freedom (because the insurers can just snap their fingers and remove market access). That’s kinda the definition of unfair market practices.

or

2.) Stay silent (keep her business operating) and accept that she cannot provide care to her patients (lose her professional rights)

That’s a bad situation in the markets.

So, what do they do? They send in the pharmacists.

Texas is hot this Midterm. It’s in the middle of a lot of action, like my state of Minnesota.

1 Like
28

What we expect from every single human being is action; not intention. Every one of us are guilty of not doing things we should do. Many of us are guilty of not doing things we say we will do. IRL we are only judged on what we do. The most reprehensible, hypocritical, politician or priest will only ever be judged on what he did, not what he said.

As for the rest of us, we must just be careful what we say. It’s all recorded.

29

The companies retaliate, @jbowler. I’m talking online with a nurse about this today.

Providers are super vulnerable to retalliation. I felt a lot less mad at them once I understood this. I had to talk to them a lot before I understood that. It was a relativley long process to establish forgivness - maybe 6 months ior a year of discussing it online before I understood. Part of forgivness was seeing them talk about it openly. I needed to see action from some of them.

I watched some bad things happen to some of them. Pharmacists with families to support would go into hiding and stop talking about problems in healthcare. People who I knew personally would state openly that their jobs were under threat if they continued to discuss PBM reform. They would go radio silent.

I try not to put them at risk. If they speak openly about things, then I will speak with them. But I let them make those moves first.