One of the rare bipartisan areas of agreement in Congress right now is the need to rein in these Pharmacy Benefit Managers (PBMs). Both Republicans and Democrats had rallied around reforms to increase PBM transparency, which could lower costs for employers and, eventually, consumers.
But just as a major PBM reform bill was set to pass last December, Elon Musk fired off a series of tweets opposing it. Within hours, what had been near-unanimous support collapsed. Five days later, Musk tweeted, "What is a pharmacy benefit manager?"—as if he had only just learned about the issue.
This isn’t about whether Musk was right or wrong on PBMs (though evidence suggests reform would lower costs). The bigger issue is how a single billionaire’s influence can derail democratic processes that were functioning as intended. When a reform has broad bipartisan support, expert backing, and clear public benefits, yet can still be nuked by one well-placed tweet, that’s not just a policy failure—it’s a governance problem.
Tech billionaires reshaping policy via social media whims should concern anyone who cares about democratic accountability. If Musk can tank a bill that helps millions save on prescriptions, what else can be undone with a midnight tweetstorm?
I worked for a PBM in the late-90s. I wish I would've sold crack cocaine and guns to children. I would've felt better about myself. ... Hyperbole, indeed, but wow, that company, and PBM industry, was shady as fuck.
That whole situation was so strange to me. I was in my mid-20s at the time, trying to make sense of the "adult world". Then they tell me something is both illegal and legal at the same time, depending on how your label it - like Schrodinger's cat, but dumber.
And that's when I really started to feel dirty about working for the PBM. I knew the company was part of the machine, helping push drugs onto people, purely driven by profit, not actual need. Like, I dealt with drugs dealers a bunch in college (weed, ecstasy), and none of them ever tried to push drugs onto me. They just sold it, and that was it. But I really started to see how this whole machine operated, and I was part of it. :'(
It's not that easy. The deeper issue is plurality voting and duverger's law, with people being incentivized not to vote for something but to vote against a perceived evil, as that's what the campaigns get more traction with on the whole.
Plurality voting applied to the tragedy of the commons, i.e. the nash equilibrium decision matrix, results in the worst possibility if there's no basis for trust. If we could vote on the results of that matrix, by replacing {+1, 0, 0, 0...} voting with {+1, +0.5, -0.5, 0, 0, 0...} voting, things might actually improve with 3-4 viable, local parties, with smart selection of candidates actually representing districts constructively and campaigning accordingly.
But we don't have that. I fear its absence at all scales from local right on up to resolution of international conflict may end up being the Great Filter: The coordination problem of solving the tragedy of the commons in all its forms.
Hold on. That bill contained the PBM stuff, but that doesn’t mean he was wrong about it being full of pork - though I don’t know one way or the other.
They certainly could have just done the PBM reforms in a separate bill instead of shoving it into something else…but then they potentially wouldn’t be able to get their own choice cuts of pork passed.
Anyways, seems odd to blame Musk directly for that even if his tweet did kill the bill.
> seems odd to blame Musk directly for that even if his tweet did kill the bill
Musk tanked a bill he obviously didn't read with zero plans for its replacement. So instead of a $1.7 trillion bill in December, we get roughly the same bill (that's what a continuing resolution is) plus $100bn in giveaways in March minus the PBM reforms.
Musk killed PBM reform. The fact that he was too high to know what he was doing isn't exactly redemption.
But just as a major PBM reform bill was set to pass last December, Elon Musk fired off a series of tweets opposing it. Within hours, what had been near-unanimous support collapsed. Five days later, Musk tweeted, "What is a pharmacy benefit manager?"—as if he had only just learned about the issue.
This isn’t about whether Musk was right or wrong on PBMs (though evidence suggests reform would lower costs). The bigger issue is how a single billionaire’s influence can derail democratic processes that were functioning as intended. When a reform has broad bipartisan support, expert backing, and clear public benefits, yet can still be nuked by one well-placed tweet, that’s not just a policy failure—it’s a governance problem.
Tech billionaires reshaping policy via social media whims should concern anyone who cares about democratic accountability. If Musk can tank a bill that helps millions save on prescriptions, what else can be undone with a midnight tweetstorm?