> so they buy pharmacies and gouge the costs of cheap medicine to make up for the lost profits. Instead of paying $5 for insulin, they make you pay $60, which h

> so they buy pharmacies and gouge the costs of cheap medicine to make up for the lost profits. Instead of paying $5 for insulin, they make you pay $60, which helps them hit the 80% rule. Yah, that's not really true. Sure if they can increase healthcare costs, then they can increase premiums, but that also makes them less competitive. But the bigger reason it's not true is that insurance companies don't set the reimbursement rate for drugs in the first places. Instead that's set by PBM's, which are separate companies. Insurance companies hate PBM's because the PBM's prevent the insurance companies from doing exactly like you describe. (This hate translates into a lot of badmouthing which I'm sure you'll find if you lookup PBM's. They get called "middlemen" who take money and don't provide a service - this is just propaganda by insurance companies.) The whole hero worship of Luigi is based on a complete misunderstanding of who actually causes healthcare costs to be high. It's not insurance companies or PBM's! It's actually Dr's and hospitals. It's not trendy to hate those though.