For decades, reformers have tried to move American health care away from cost-plus reimbursement and open-ended fee-for-service medicine toward competition, in which private plans negotiate hard and shift business to those offering better value. The new PBM regime would move in the opposite direction: toward regulatory supervision, standardized participation, and reduced discretion.
This article was featured on Hacker News on February 21, 2026. You can read the discussion here.
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