The Dictatorship
Big Medicine threatens your wallet and your health. But there is a solution.
ByEmma Freer
When Congress passed a spending package earlier this year, few industries were more disappointed than pharmacy benefit managers. PBMs are middlemen who liaise between insurers, drug manufacturers and pharmacies to determine which drugs are covered at what price. Their job, as the New York Times reported in 2024“is to reduce drug costs. Instead, they frequently do the opposite. They steer patients toward pricier drugs, charge steep markups on what would otherwise be inexpensive medicines and extract billions of dollars in hidden fees.”
The spending bill’s provisions limited some common PBM practices, and the industry declared itself sufficiently regulated. But policymakers are rightly refusing to move on. They are now proposing even more aggressive legislation that would extend not just to PBMs but to other “Big Medicine” middlemen — such as insurance conglomerates and wholesale drug distributors — that drive healthcare costs up and independent providers out of business.
Americans receive middling healthcare yet face the highest medical costs in the world. Meanwhile, six of the country’s 15 most valuable companies are Big Medicine conglomerates, more than from any other sector, including Big Tech. Together, these six generated nearly $34 billion in profits last year alone, according to annual reports.
Big Pharma abuses patents to keep drug costs high and block competition from more affordable generics. But that doesn’t let Big Medicine off the hook.
PBMs demonstrate, in microcosm, the Big Medicine problem. The “big three” PBMs — CVS Caremark, Cigna’s Express Scripts and UnitedHealth Group’s Optum Rx — not only control 80% of U.S. prescriptions but also are each vertically integrated with a major insurance conglomerate and a major pharmacy. There is overwhelming evidence that these three companies leverage their market power to drive drug costs up and independent pharmacies out of business. For example, a 2025 report by the Federal Trade Commission found that the big three PBMs paid their affiliated pharmacies up to 7,736% more than unaffiliated competitors.
In addition to the three PBM parent companies are three drug wholesalers: McKesson, Cencora and Cardinal Health. They control 96% of U.S. drug distribution and, like the PBMs, are increasingly vertically integrated with medical providers, including oncology clinics and other specialty practices with high drug costs. This arrangement is rife with conflicts. For instance, in March 2026, Cencora agreed to pay $1 million to resolve allegations that (in the words of the Justice Department) “it violated the False Claims Act by paying kickbacks to health care providers (HCPs) and medical practice executives to induce them to purchase specialty pharmaceutical products.” In other words, wholesalers’ profit margins rather than doctors’ clinical judgment can dictate which drug a patient receives in the chemo chair or during another potentially lifesaving treatment.
PBMs have been quick to point the finger elsewhere, recently launching a seven-figure advertising campaign to blame the pharmaceutical industry for high drug costs. To be clear, Big Pharma abuses patents to keep drug costs high and block competition from more affordable generics. But that doesn’t let Big Medicine off the hook. Unfortunately, even incremental PBM reform efforts stalled for years in the face of fierce opposition from industry groups. Elon Musk even played a supporting role, tanking a bipartisan government funding bill that included PBM reforms at the behest of President Donald Trump. (Musk later admitted he didn’t even know what a PBM was.)
Lawmakers were finally able to get reforms into a different spending bill, which Congress passed in February. The provisions included banning PBMs from pocketing manufacturer rebates, excluding independent pharmacies from their networks in Medicare Part D or withholding certain pricing information from employer health plan sponsors.
But these reforms left the big three PBMs’ vertically integrated business model intact. So policymakers are starting to broaden their focus. Deep-red Arkansas and Tennessee have passed laws prohibiting PBMs from owning pharmacies. Although the laws have yet to take effect, research estimates that such a ban would reduce drug prices by more than 7%. This is likely a conservative projection, given the FTC’s findings.
This bill would break up all six of the Big Medicine companies in an effort to lower healthcare costs and promote competition.
At the federal level, earlier this year Sens. Elizabeth Warren, D-Mass., and Josh Hawley, R-Mo., introduced the Break Up Big Medicine Actwhich would prohibit insurers, PBMs and wholesalers from owning or controlling healthcare providers, including medical practices and pharmacies. In practice, this bill would break up all six of the Big Medicine companies in an effort to lower healthcare costs and promote competition. Indeed, research shows that UnitedHealthcare — the insurer arm of UnitedHealth Group — pays its affiliated Optum medical providers 17% more than competitors and up to 61% in markets where UnitedHealthcare has 25% or more market share.
Public support for this kind of legislation is mounting. A Morning Consult poll from May found that more than 80% of voters agreed that health insurance companies “have too much control over medical decisions” and “drive up costs without investing in the healthcare needs of the patients they cover.” Business leaders like Mark Cuban, the billionaire co-founder of Cost Plus Drugs, endorse breaking up these companies. My organization, the American Economic Liberties Project, is part of a coalition of 25 organizations — representing patients, clinicians, employers and policy experts — that support the Break Up Big Medicine Act.
During the Great Depression, President Franklin Delano Roosevelt signed into law the Glass-Steagall Act, which structurally separated commercial banks from investment banks, given the systemic risks of their common ownership. Big Medicine poses a similarly catastrophic threat to the U.S. healthcare system. The Break Up Big Medicine Act won’t heal all of the system’s problems, but it will begin the path to recovery.
Emma Freer
Emma Freer is a senior policy analyst for health care at the American Economic Liberties Project, a nonpartisan advocacy group that opposes the concentration of economic power.
The Senate Judiciary Committee postponed a vote on acting Attorney General Todd Blanche’s nomination, a spokesperson said late Wednesday, as two retiring Republicans on the panel dug in over President Donald Trump’s personal “anti-weaponization” deal with the government he runs.
Sen. Chuck Grassley’s decision to delay the committee vote that had been set for Thursday marks a setback for one of Trump’s highest-profile Cabinet nominees, at the hands of Texas Sen. John Cornyn and Sen. Thom Tillis of North Carolina, a pair of Republicans set to leave the chamber next year.
“Chairman Grassley works to set President Trump’s nominees up for success in committee, not failure. Senators Cornyn and Tillis want written assurances from the Department of Justice regarding the Trump-IRS settlement,” the committee spokesperson said.
Blanche’s nomination to permanently head the Department of Justice needs the support of either Cornyn or Tillis to make it out of the committee to a vote by the full Senate, assuming all Democrats remain opposed.
“Why don’t you call over the Department of Justice and tell them they have one hour and 50 minutes to get me what I asked for,” Cornyn told reporters Wednesday afternoon amid the hardening standoff over his demand that Blanche and the DOJ put in writing a commitment never to pursue the president’s prized “anti-weaponization” fund, and to clarify the terms of Trump’s personal deal with the Internal Revenue Service.
Tillis told MS NOW that the conversations were complicated by the need for the Justice Department to get “several parties” to agree on the language of the statement Cornyn and Tillis are seeking.
“What I’ve advised the chair, and I would assume Senator Cornyn said something similar, is that we’re not prepared to vote yes yet,” he added.
“The Department has been in regular communication with Committee members for weeks, and we look forward to continuing to work productively with Senators to address any concerns,” a Justice Department spokesperson said in response to the decision to postpone the committee vote.
Cornyn was set to meet with Blanche on Wednesday morning, but the meeting was called off after Blanche failed to meet the senator’s demand for written proposals to modify the controversial settlement agreement he brokered between Trump and the IRS. The Republican senator is set to leave Congress when his term ends in January after a bruising May primary loss to Texas Attorney General Ken Paxton, Trump’s chosen candidate.
“Maybe John Cornyn’s upset with me because I didn’t endorse him,” Trump told reporters Wednesday afternoon in the Oval Office. “I don’t know what it is, but I haven’t heard that there’s a problem. I heard (Blanche) is going through quite nicely.”
Cornyn made clear to Blanche during his confirmation hearing that he will not get his support until he agrees to reopen and modify the settlement. Due to the committee’s narrow Republican majority, one GOP “no” vote is enough to sink Blanche’s nomination.
The senator has asked Blanche to provide proof that the proposed nearly $1.8 billion “anti-weaponization” fund established as part of the deal between Trump and the IRS is formally dead, and he has also demanded Blanche narrow the tax audit immunity provisions the settlement afforded to Trump and his family.
Blanche has publicly stated that his department has dropped the fund, but he and the DOJ have dodged requests from Cornyn and a federal judge to put that in writing.
After announcing his meeting with Blanche would not take place Wednesday morning, Cornyn told reporters that changes from Blanche “in a modified release form” would be acceptable, but that “for some reason … they simply refuse to do it,” referring to the DOJ.
Shortly after the meeting was called off, a Justice Department official told MS NOW that the department “provided a written proposal to Senator Cornyn’s staff yesterday following ongoing discussion with both the Committee and the Senator’s office.”
Cornyn said that proposal was “not responsive” to his demands because it did not address the tax audit immunity provisions in the settlement, one of his key demands.
In May, Blanche signed an addendum as part of the deal that granted Trump, his family and his businesses immunity from pending IRS tax audits. That agreement, which has been decried by former IRS officials and legal experts as unlawful self-dealing, is being contested in federal court.
Cornyn noted that Blanche testified under oath that he could meet the request during his confirmation hearing.
“Maybe they think I’m just going to give up or you know, go along, but they’re mistaken,” Cornyn said when asked why he thinks the DOJ could be slow-walking his request.
Kevin Frey contributed to this report.
Sydney Carruth is a breaking news reporter covering national politics and policy for MS NOW. You can send her tips from a non-work device on Signal at SydneyCarruth.46 or follow her work on X and Bluesky.
Mychael Schnell is a reporter for MS NOW.
Ebony Davis is a breaking news reporter for MS NOW based in Washington, D.C. She previously worked at BLN as a campaign reporter covering elections and politics.
When Israeli Prime Minister Benjamin Netanyahu arrived this week for his tour of Washington, he may have had a mission in mind.
Netanyahu needed to overcome his newly diminished stature and waning influence over his once close friend President Donald Trump as both leaders grapple with the unpopularity of a war they started together and is escaping their control.
His meeting at the White House with Trump on Tuesday, which was closed to the press, was the first face-to-face encounter between the two allies since the U.S. and Israel launched a joint attack against Iran on Feb. 28.
Trump gave him a muted welcome and afterwards simply described the meeting as “very good.” “Obviously, many important subjects were discussed,” the president wrote on Truth Social.
Rather than an intimate one-on-one setting, the Oval Office was full of top U.S. officials — Vice President JD Vance, Secretary of State Marco Rubio, Treasury Secretary Scott Bessent, Secretary of Defense Pete Hegseth, Chairman of the Joint Chiefs of Staff Gen. Dan Caine, and special envoy Steve Witkoff.
But Netanyahu continued the full court press on the Trump administration.
Over the course of two days, in addition to seeing Trump and attending Sen. Lindsey Graham’s funeral at the Capitol, Netanyahu also met separately with Vance, Hegseth, and Rubio, White House and Israeli officials confirmed to MS NOW.
The Israeli prime minister’s slate of meetings with key U.S. national security officials comes at a pivotal moment in the Iran conflict as tensions escalate in the region and Americans increasingly sour on the war. A recent Quinnipiac poll shows 60% of American voters opposing U.S. military action against Iran and 74% against sending U.S. ground troops into Iran.
Not only does Trump face pressure as Republicans face an uphill battle to retain congressional control in this fall’s midterms, Netanyahu’s fate as prime minister is at stake in Israel’s upcoming September elections – and he can’t afford to lose Trump’s favor.
The talks largely focused on what to do next as Iran continues to menace shipping in the Strait of Hormuz and retaliate against American bases in the region and launch attacks on Gulf allies.
According to a senior Israeli official who was granted anonymity to describe the closed-door meeting, President Trump and Israeli Prime Minister Netanyahu did not come to a final decision after discussing three paths forward: get a “good deal” focused on Iran’s nuclear program and enriched material, have no deal and instead continue the blockade and economic pressure, or take escalated military action.
But Netanyahu did not tell Trump what he should do – nor did he express a preference.
The senior Israeli official noted Netanyahu has not ruled out diplomacy – as long as it is coupled with “very strong pressures,” calling the push to dismantle Iran’s nuclear program “a contest of will and a contest of force.”
“There are ways of squeezing them and squeezing them and squeezing them and negotiating at the same time,” the official said.
Netanyahu did not present President Trump with new intelligence regarding the underground Iranian nuclear facility Pickaxe Mountain, per the senior Israeli official, noting the U.S. and Israel already are constantly sharing intelligence – and know where Iran’s highly enriched material is. “We don’t think it’s moved, and I think we have a pretty good grasp on that,” the official said.
During their meeting on Tuesday, Trump and Netanyahu discussed ways Israel and the U.S. can work together to stop Iran’s nuclear program and get the Strait of Hormuz open to maritime trade, the senior Israeli official said.
The two leaders also discussed a third goal: to continue to undermine the Iranian regime and “possibly create future conditions for a change in that area.” U.S. officials have backed away from pursuing paths that would overthrow the current leadership, but Netanyahu still believes that could happen.
“The chasm that has been created between the people and the regime is not about to be closed,” the senior Israeli official said of Netanyahu’s thinking.
Netanyahu advised Trump in February that Israeli intelligence indicated launching strikes against Iran would lead to the toppling of the Islamic Republic’s regime – and five months later, the slain ayatollah’s son retains power with a close circle of hardliners, calling into question the accuracy of Israel’s intelligence apparatus.
But the senior Israeli official said at the time, Netanyahu did not promise the Iranian people would take fate into their own hands following a coordinated attack. Rather, he chose his words carefully and said that an attack could create conditions to “advance the probability or the possibility that that would happen.”
The conditions needed for the Iranian regime to fall, “did not materialize,” the official told MS NOW, adding, “not for lack of insight, but for either operational failure or decisions that were made.”
Despite Netanyahu insisting Israel and the U.S. are on the same page, differences still remain: the sale of F-35 fighter jets to Turkey and the Saudi nuclear arrangement did not come up during Wednesday’s White House meeting, according to a second Israeli official granted anonymity to describe sensitive discussions.
Meanwhile, the conflict continues to spread, with an Iranian drone attacking a U.S. gas storage tanker off the coast of Egypt on Wednesday.
Trump indicated he would not let Iran’s latest action slide, telling reporters on Wednesday that the U.S. would retaliate against Iran even as he leaves room for diplomatic talks to resume.
“It’s our turn, and we’ll see if we get there with an agreement at some point,” Trump said. “But we’re going to hit them very hard.”
As for what it would take for Israel to join the U.S. strikes, the senior Israeli official said that if Israel is attacked by Iran, “We will respond very, very forcefully and very quickly. And I think Iran would make a great mistake.”
Julia Jester covers politics for MS NOW and is based in Washington, D.C.
International rage over FIFA’s close ties to President Donald Trump has reached a fever pitch after soccer’s governing body announced a plan to sell a significant stake to an investor group led by Joshua Kushner, the brother of Trump’s son-in-law.
The president and his family have all but turned the White House into their personal piggy bank. And FIFA — which has its own sordid history of corruption — seems to have made itself a party to Trump’s self-enrichment under Gianni Infantino’s leadership, such as by paying for space inside Trump Tower in New York. (The organization has defended the office rental as a World Cup outpost.)
Soccer is seen by many as a unifying game. But Trump’s incorporation of FIFA into his political dynasty is threatening that idea.
FIFA has announced plans to sell a large minority stake in a new company that will run its main events, including the World Cup and Club World Cup, as part of a plan to triple the amount of development money it dishes out to its 211 member associations.
Under the proposals — which are subject to approval by a majority of those national associations and FIFA’s 37-member council — a new entity called FIFA Forward Enterprises (FFE) will take over all commercial operations, while FIFA remains the game’s global governing body and retains a majority stake in FFE.
A press release from FIFA confirmed the plans and said Thrive Eternal, which was launched by Joshua Kushner, is expected to lead the investment group that would control FIFA Forward Enterprise. FIFA did not clarify why Thrive Eternal was selected, and Kushner was already dabbling in sports.
But Trump basically has already given son-in-law Jared Kushner carte blanche to dictate U.S. foreign policy in the Middle East while simultaneously hatching business plans in the region. (Jared Kushner has denied any conflicts of interest.)
Joshua Kushner reportedly has been a major donor to Democrats. But, predictably, the idea of another Kushner becoming financially entwined with the World Cup — the world’s most popular sporting event — and basically being dropped into a position of global significance isn’t going over well. Several other soccer governing bodies have expressed concerns, including Europe’s UEFA.
“This crosses a line that football’s governing institutions should never cross,” UEFA said in a statement about The Athletic’s report, adding: “The soul and governance of football are not assets to trade — especially with zero transparency as to who gains financially. None of us are the owners of football. It is not FIFA’s to sell.”
Democrats on the House Judiciary Committee also rebuked the plan, writing on X: “Apparently the fake Peace Prize and giant lease with Trump Tower weren’t enough — now Infantino performs a kickback hat trick by pursuing a multibillion-dollar deal with Jared Kushner’s brother to sell ownership stakes in the World Cup to private investors.”
FIFA, Donald Trump’s favorite corrupt racketeering enterprise in world sports, is now going directly into business with the Trump family!
Apparently the fake Peace Prize and giant lease with Trump Tower weren’t enough—now Infantino performs a kickback hat trick by pursuing a… https://t.co/knSZibuMea
— House Judiciary Dems (@HouseJudiciary) July 28, 2026
Rep. Jamie Raskin, D-Md., has already launched an investigation into the FIFA leader’s relationship with the Trump administration, while dozens of European lawmakers — citing concerns about “potential breaches of political neutrality” — have called for the FIFA Ethics Committee to investigate Infantino. This new proposal seems unlikely to assuage those concerns.
But what it does seem likely to do is fuel global anger toward the U.S. — the kind that has been growing since Trump retook office.
And when you consider that, it’s truly remarkable how the same MAGA movement whose members whined for years about politics mixing with sports is now in lockstep with a president who seems dead-set on casting his shadow over every sports event he can.
This post on X basically sums up the foul stench around FIFA’s latest proposal.
Sepp Blatter was Infantino’s predecessor as FIFA president and oversaw the organization amid some of its many scandals. When heof all people, is warning about how Trump and Infantino’s relationship is “deeply damaging” soccer, it’s a sign of how far FIFA has descended into the gutter.
Ja’han Jones is an MS NOW opinion blogger. He previously wrote The ReidOut Blog.
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