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Let's discuss UnitedHealthcare, particularly in light of its recent leadership changes. Last year, they generated $373 billion in revenue, with 60% coming from their pharmacy benefit manager, a largely unknown entity. The public and politicians often overlook the significant role of health insurance companies, which I mentioned on Rogan. While there's a lot of focus on Big Pharma, which made about $600 billion, health insurance companies generated 2.5 times that amount, totaling $1.5 trillion. Projections indicate they could reach $1.9 trillion in revenue by 2029.

One breast cancer drug costs over $16,000 per bottle in America. The same drug, from the same factory and company, costs one sixth the price in Australia. In Sweden, the identical product costs one tenth the American price.

The speaker claims the United States spends $1,126 per capita on drugs, while Britain spends about $240, approximately one-fifth of the U.S. figure, a trend seen across Europe. The speaker says drug companies claim America must pay for pharmaceutical innovation. President Trump is quoted as saying European partners need to increase their drug payments to cover their share of innovation, asserting the U.S. should no longer subsidize it. The speaker concludes that if Europeans raised drug prices by 20%, the resulting $10 trillion could be spent on innovation, improving global health.

At the end of World War II Asia and Europe were devastated, and the United States emerged as the last man standing, profiting hugely from the war. They ended up, due to isolation, the strongest economy in the world with more than half the world’s gold and half the world’s GDP, with standing industries that could shift from making tanks to making cars and trucks. They did extraordinarily well for a few decades, but then, as described, they began to financialize, and it became more profitable to speculate in investments than to actually invest. In recent years, companies with money often pursue share buybacks rather than expanding research and development or industrial capacity. We are in a stage where the underlying basis for markets is questionable: what are markets for, are they accurate at price discovery, and do they predict productive investment and returns on capital? We are in a transition phase where we’re not sure anymore. There is a huge bubble, and corporations creating these bubbles, with banks that loan money relying on the state because they are too big to fail. Bailouts have totaled trillions since 2008, as the US Federal Reserve, the European Central Bank, the Bank of England, and the Bank of Japan pumped trillions of dollars, with help from Gulf Cooperation Council countries to bail out banks in Britain, the United States, and Europe. It’s fascinating because China, since the financial crisis, has also created about 17 to 18 trillion dollars. China has actually been leading in creation of money, while investing that money in building 50,000 kilometers of high-speed rail, a space program, massive industries, and the Belt and Road initiative—real investment and so on. The enormous difference between the two is notable, but how far can states—the United States, Britain, the EU, and Japan—borrow and pump money into the market to keep this bubble going? We don’t know. Bubbles are hard to gauge in terms of expansion and when they break, which is why they can be sustained so long; the bursting of a bubble is painful, and no policymaker wants responsibility. China is interesting and is the only case in history of a property bubble being deflated without collapsing the real economy, deflating its property bubble over five or six years while the economy continued to grow—not at 8% but at 5%—and continued to expand. That is worth studying because other countries let property bubbles run until they burst, causing wider harm and deflation. Japan, for example, has had thirty years of zero growth since it began quantitative easing three decades ago, a growth killer because it protected existing companies, banks, and properties and never really recovered. Europe has had zero growth for about fifteen years since 2007. The United States sustains growth largely by buying it from the rest of the world—acquiring profitable companies or getting them to list on NASDAQ and then earning rents from profitable companies wherever they are—while the US economy has been largely hollowed out. It’s an interesting time to watch monetary dynamics, because this doesn’t go on forever.

Pharmaceutical companies generate over two-thirds of their profits in the United States, despite the U.S. accounting for only 4% of the world's population. The speaker expresses respect for pharmaceutical companies and their leadership. They believe these companies successfully convinced people for many years that the current system was fair, even though the reasons why were not widely understood.

Pharmaceutical companies claimed research and development costs had to be borne by America alone, which effectively meant American patients were subsidizing socialist healthcare systems in places like Germany and the European Union. The speaker believes the European Union is nastier than China and has treated the U.S. unfairly. However, the speaker asserts that the U.S. now holds all the cards and expects the European Union to concede.

The administration will secure "most favored nations" drug pricing, meaning Americans will pay the lowest price for drugs paid in other developed countries. Some prescription drug prices will be reduced almost immediately by 50 to 90%. Big Pharma will either abide by this principle voluntarily, or the federal government will ensure Americans pay the same price as other countries. To accelerate price reductions, the administration will cut out the middlemen and facilitate the direct sale of drugs at the most favored nation price directly to American citizens. The middlemen are considered worse than the drug companies because they don't make a product but make a fortune.

The U.S. spends $1,126 per capita on drugs, while Britain spends about $240, roughly one-fifth of the U.S. amount, a trend seen across Europe. Drug companies claim America must pay for innovation. President Trump argues that European partners need to increase their drug payments to cover their share of innovation, asserting the U.S. will no longer subsidize them. If Europeans raise drug prices by 20%, $10 trillion could be spent on innovation, improving global health through better products.

Pharmaceutical companies generate over two-thirds of their profits in the United States, despite the U.S. accounting for only 4% of the world's population. The speaker expresses respect for pharmaceutical companies and their leadership. They believe these companies successfully convinced people for many years that the existing system was fair, even though the reasons why were not well understood. The speaker claims to have figured out the reasons behind this.

Big pharma will likely profit significantly from this medication, which is intended for long-term or potentially lifelong use.

Pharmaceutical companies claimed high R&D costs had to be borne solely by America, effectively subsidizing socialist healthcare systems in countries like Germany and the European Union. The speaker believes the European Union is "nastier than China" and has treated the U.S. unfairly, but predicts they will concede because the U.S. "has all the cards."

American taxpayers fund basic and late-stage clinical research for the entire world, largely through the NIH. While Europe and private foundations contribute, the NIH is the single largest global investor in basic science and applied research. Higher U.S. drug prices also fund the phase three trials and R&D efforts conducted by drug companies. Therefore, American taxpayers are essentially the world's piggy bank for almost all of the research pipeline.

The Doge report reveals that US healthcare corporations spent 95% of their income on shareholder payouts, totaling $2,600,000,000,000 over the last 20 years. US taxpayers reportedly pay about 70% of these fees. Additionally, $2,700,000,000,000 in taxpayer money has allegedly been improperly paid out in Medicare and Medicaid to people outside of the United States.

We're paying too much for drugs compared to other countries, and existing laws make it hard to lower costs. The middlemen in the drug industry are profiting significantly without adding value. We're going to eliminate these middlemen to reduce drug prices to unprecedented levels. This topic dominated our discussions with executives and others involved.

American patients were subsidizing socialist healthcare systems in the European Union. The European Union is nastier than China, but they will come down a lot. The U.S. has all the cards because the EU treated the U.S. unfairly. The EU sells the U.S. 13 million cars, but the U.S. sells them none. The EU sells the U.S. their agricultural products, but they don't take U.S. products. Because of this unfairness, the EU will have to pay more for healthcare, and the U.S. will have to pay less.

The speaker states that the U.S. will tariff pharmaceuticals. They believe this will cause pharmaceutical companies to move back to the U.S. because the U.S. is the biggest market. The speaker asserts that the U.S.'s advantage is being the biggest market. They say a major tariff on pharmaceuticals will be announced shortly. The speaker believes that upon hearing this, pharmaceutical companies will leave China and other places because most of their product is sold in the U.S.

One breast cancer drug costs Americans over $16,000 per bottle. The same drug, from the same factory, manufactured by the same company, costs one-sixth the price in Australia. In Sweden, the identical product costs one-tenth the price.

Vaccines generate significant profits for companies. Adding just one vaccine to the infant child schedule can result in $1 billion in annual sales. The widespread COVID-19 vaccination has been highly lucrative for Pfizer, earning them $54 billion in 1.5 years. Moderna, on the other hand, made $56 billion, while Moderna made $34 billion during the same period.

Big food, big pharma, big chemicals get super wealthy. Right? What is the product of health care? It's a healthy body. If we take The US population and compare it to the world, we're at the very bottom when it comes to health, yet we spend the most for health care. Over $4,100,000,000,000 every single year.

The Doge report reveals that US healthcare corporations spent 95% of their income on shareholder payouts, totaling $2,600,000,000,000 over the last 20 years. US taxpayers reportedly pay about 70% of these fees. Additionally, $2,700,000,000,000 in taxpayer money has been improperly paid out in Medicare and Medicaid to people outside of the United States.

Americans pay significantly more for prescription drugs than other countries, sometimes up to 10 times more. Pharmaceutical companies generate two-thirds of their profits in the U.S., effectively making Americans subsidize healthcare in other countries. The administration is introducing a "most favored nation" pricing model, ensuring the U.S. pays the lowest price available globally for drugs. For example, a breast cancer drug costing over $16,000 in the U.S. is a fraction of that price in Australia and Sweden. Similarly, an asthma drug costs almost $500 in the U.S. but less than $40 in the UK. The plan involves directing investigations into foreign nations that block drug products unless they accept low prices, and the U.S. will defend drug companies from unfair pricing demands. The administration aims to cut out middlemen and facilitate direct drug sales at the most favored nation price. If companies don't comply, the U.S. will use its trade powers and open the market to safe, legal drug imports.

Pfizer is hesitant to distribute vaccines in certain countries due to liability issues. However, other vaccine manufacturers may be able to operate through subsidiaries and enter these countries. Our aim is to provide vaccines to developing nations based on their decisions. We have financing options available, but it is up to the countries to choose their systems and start procuring the vaccines.

In our annual letter, we address concerns about overpopulation as we improve global health. Contrary to fears, better health leads to smaller family sizes worldwide, as shown by a chart of population growth. By 2100, the population is projected to stabilize at 11 billion. While this is still a large number, the trend of declining family sizes with improved health is encouraging for the future.

Healthcare companies will likely make the same amount of money because it's a redistribution of wealth across the world, not just the European Union. Europe and the rest of the world will pay a little more, while America will pay a lot less. This is due to America having a smaller population compared to the entire world. The top line for healthcare companies could remain the same, but it will be distributed differently.

Trump recently announced plans to break up pharmacy benefit managers (PBMs), which are often misunderstood. PBMs were created in the 1970s to help lower prescription drug costs but have since been acquired by major insurance companies, turning them into profit centers. Instead of negotiating lower prices, PBMs negotiate higher costs to receive kickbacks from drug manufacturers. For example, 30% of the cost of drugs like Ozempic goes to PBMs as kickbacks. UnitedHealthcare generated $373 billion in revenue last year, with 60% from its PBM. While insurance companies may not have as high profit margins as big pharma, they use various methods to obscure their profits. Overall, health insurance companies generate significantly more revenue than pharmaceutical companies, highlighting the hidden influence of PBMs in the healthcare system.