By Michael Ashcraft —
Brigham Buhler: Exposing the Healthcare Profiteers and the System’s Dark Side
In the dense fog of the American healthcare system—where private insurance companies, Pharmacy Benefit Managers (PBMs), and pharmaceutical giants swirl in a haze of bureaucracy and greed—Brigham Buhler is leading the charge to liberate the American patient. His critique of the healthcare landscape is both scathing and compelling, as he uncovers how PBMs, big insurance, and even the pharmaceutical industry have built a lucrative empire at the expense of the American public’s health.
If you’ve ever wondered why your prescription costs more than a mortgage payment, or why the opioid crisis continues to decimate communities, you can thank this conglomerate of corporate interests. According to Buhler, the core issue isn’t a shortage of medical innovation or expertise; it’s a system designed to keep you sick, dependent, and a source of profits for the greedy men who disguise themselves as healthcare.
PBMs: Profit Centers, Not Middlemen
We’ve all been told that Pharmacy Benefit Managers (PBMs) are the middlemen of the healthcare world, working behind the scenes to negotiate drug prices and ensure patients get access to affordable medications. But Buhler isn’t buying it. His thesis is simple: PBMs are not neutral intermediaries; they are profit-driven entities controlled by big insurance companies, and they’re manipulating the system to line their pockets.
Imagine a shady middleman in any business deal—someone who takes a cut not by reducing costs, but by inflating prices and taking a slice of the action. That’s essentially how PBMs operate, according to Buhler. Originally, their purpose was to drive down drug costs, but in reality, they’re distorting the market by pocketing rebates and incentives from manufacturers, all while pretending to serve the public good. Buhler calls it a “bait and switch” of epic proportions.
Big Insurance: Masters of Exploitation
If you thought your insurance company was on your side, think again. Buhler paints a grim picture of the true role major insurers like UnitedHealthcare, Cigna, and CVS Health (via their PBMs) play in the healthcare system. They’ve turned healthcare into a massive for-profit enterprise, putting the interests of shareholders above those of patients. This isn’t news to anyone who’s tried to navigate the labyrinthine insurance claims process or been shocked by a co-pay that seems designed to bankrupt you.
Buhler suggests that these behemoths thrive on keeping people sick—because healthy people don’t generate the kind of revenue that chronic conditions do. The more diseases you have, the more insurance companies profit. As Buhler bluntly puts it, “If I can monetize your diabetes, why would I cure or prevent it?” That statement isn’t just cynical; it’s a brutally accurate description of a system where chronic illness fuels a multibillion-dollar industry.
Insulin: A Case Study in Corporate Greed
Take insulin, a life-saving drug for millions, as an example. While insulin manufacturers have lowered prices (a 30.8% decrease between 2014 and 2018), PBMs and insurers have managed to hike the costs through rebates and pricing schemes that benefit themselves, not the patient. Buhler points out that PBMs’ share of insulin expenditures increased by a staggering 154.6% during the same period, despite price cuts by the manufacturers. The result? Patients are still paying through the nose for a drug that should be much cheaper.
This isn’t just bad luck. It’s a deliberate strategy. PBMs and insurers profit from inflated prices, and the rebate system they’ve created only makes matters worse. Pharmaceutical companies give PBMs discounts on drugs, but instead of passing those savings onto patients, PBMs pocket the difference. The more expensive the drug, the bigger the rebate—so PBMs have an incentive to promote high-cost medications like insulin, rather than cheaper alternatives.
The Rebate System: How It Fuels High Prices
The rebate system is one of the most egregious examples of how the healthcare system exploits patients. Buhler argues that the very structure of rebates incentivizes pharmaceutical companies to set high list prices on drugs, knowing that PBMs will extract massive discounts, which then aren’t passed on to consumers. This creates a vicious cycle where patients are stuck paying high out-of-pocket costs, while PBMs and insurers rake in massive profits.
If you’ve ever felt like you were getting the short end of the stick at the pharmacy counter, this is why. The rebate system turns healthcare into a high-stakes game where the only winners are the corporations involved. And as Buhler notes, those rebates aren’t about lowering prices for patients—they’re about keeping the money flowing to the big players in the healthcare industry.
Opioids and Addiction: Profits Over People
One of the most damning aspects of Buhler’s argument is his critique of how insurance companies and PBMs have handled the opioid crisis. While millions of Americans suffer from addiction and overdose deaths, insurance companies and PBMs have profited handsomely by steering patients toward addictive opioids rather than safer alternatives like topical ketamine pain creams.
The opioid epidemic didn’t happen by accident. Buhler points out that companies like Purdue Pharma, in collusion with PBMs and insurers, pushed opioids on patients who could have been treated with safer, non-addictive options. These entities profited “hundreds of millions” of dollars while devastating communities across the nation. And once again, it all comes back to the same basic principle: addiction keeps people coming back for more, which means more money for the healthcare profiteers.
The Healthcare System: Symptom Management Over Cure
At the heart of Buhler’s critique is the observation that the healthcare system is designed to manage symptoms, not cure diseases. This might sound like an overstatement, but Buhler makes a compelling case. Curing a disease means losing a patient, and in the profit-driven world of healthcare, that’s a problem. If the healthcare system could cure diabetes, for example, it would put an entire industry out of business. But if it can’t cure the disease, it can keep the patient on expensive medications indefinitely, generating steady revenue for the insurance companies and pharmaceutical companies that are running the show.
The typical doctor’s visit is another part of the problem. With average visit times hovering around six minutes, there’s little opportunity for doctors to explore preventive measures like diet and lifestyle changes. Instead, they’re encouraged to prescribe medications that only mask symptoms—another way to keep the cash flowing.
PBMs’ Market Control: The Monopoly Problem
The consolidation of power in the hands of the top three PBMs—CVS Caremark, Express Scripts, and OptumRx—is another of Buhler’s concerns. Together, these three companies control approximately 80% of the U.S. prescription market, which gives them enormous leverage over drug access and pricing. This monopoly allows PBMs to dictate what drugs are available, which pharmacies can fill prescriptions, and how much patients will have to pay.
The result is a market that stifles competition, limits patient choice, and drives up prices. Independent pharmacies are sidelined, and patients are left with little recourse. This lack of competition only exacerbates the problem, making it harder for patients to find affordable medications or explore alternative treatment options.
Lack of Transparency: The Hidden Costs
If there’s one thing that stands out in Buhler’s critique, it’s the sheer lack of transparency in the system. PBMs and insurance companies operate behind a curtain of secrecy, making it nearly impossible for patients to understand the true costs of their medications. Even the federal government has limited visibility into drug pricing due to PBM “safe harbor” protections, which allow these companies to hide behind vague agreements and secret deals.
This lack of transparency not only makes it difficult for patients to make informed decisions, but it also allows the system to continue profiting at the expense of those who need help the most. Buhler argues that without transparency, there’s little hope for meaningful reform.
The Solution: Dismantling PBMs
So, what’s the solution? According to Buhler, the only way to fix this broken system is to dismantle PBMs altogether. He advocates for the breakup of these corporate giants, following the lead of figures like Donald Trump and Robert F. Kennedy Jr., whom he has briefed on the issue. Without PBMs driving the system, Buhler argues, insurers would have less incentive to keep patients on expensive drugs, and the focus could shift to prevention and long-term health.
It’s a radical idea, but given the current state of the healthcare system, perhaps it’s the only way forward.
Conclusion: The Need for Reform
Brigham Buhler’s critique of the American healthcare system is as harsh as it is necessary. By exposing the ways in which PBMs, big insurance companies, and pharmaceutical corporations collude to profit off the backs of sick patients, he’s shining a light on a system that prioritizes money over health. If we’re ever going to fix the healthcare system, Buhler believes it will take bold action—breaking up monopolies, eliminating profit-driven middlemen, and shifting the focus from symptom management to true cures.
In the end, Buhler’s message is clear: healthcare should be about healing, not exploiting the sick for profit. Until we recognize that, we’ll continue to live in a system that thrives on our dependence, not our health.
Michael Ashcraft is the editor-in-chief of Pilgrim Dispatch.
