Marty Makary on Administrative Waste and PBM Rent-Seeking: warns against

Dr. Marty Makary warns that brokers, pharmacy benefit managers, and claim adjudicators siphon healthcare spending without adding care. At his September 28, 2026 American College of Surgeons lecture, he said PBMs “charge the employer for each drug their employees take, pay less to the pharmacy, and pocket the rest” — and he noted that physicians make 30% less, inflation-adjusted, than they did in 2001, even as system-wide spending balloons.

Makary’s stated reasoning is that administrative middlemen are one of the four major problems in healthcare: they extract revenue from a system that then underpays the clinicians who actually deliver care. He presents this as both a pricing failure and a trust failure.

This is Makary’s position, attributed to him.

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