By Coach Manny A.
In Part 1, we peeled back the curtain on how our healthcare system isn’t really built for health at all — it’s built for management. Management of symptoms. Management of risk. Management of patients as recurring revenue streams.
So naturally, in a system that thrives on you never fully getting better, medication becomes the star of the show.
Let’s get something straight: medicine is not the enemy. There are life-saving drugs out there that truly change lives. The issue? The system that controls them is rigged to the point of absurdity.
Same Drug, 10x the Price
Here’s a fun experiment: Call three pharmacies and ask how much it would cost to pay cash for a common medication — say, a generic antibiotic or blood pressure med. You’ll get three wildly different answers. Then ask your insurance provider and you’ll get a fourth number.
Sometimes the cash price is cheaper than your copay.
Sometimes it’s 10x more expensive.
Sometimes your medication just isn’t covered at all, despite being necessary.
Why? Because the pharmaceutical pricing game isn’t based on logic or cost of production. It’s based on contracts, kickbacks, rebates, and whatever the pharmacy benefit manager (PBM) decides is “preferred.”
The Real Drug Dealers: PBMs
PBMs were supposed to be the middlemen negotiating better prices between drug manufacturers and insurance companies. Instead, they’ve turned into power players who set formularies (aka what drugs are covered), extract massive rebates from pharma companies, and pocket the profits while leaving patients with the bill.
Let that sink in — a shadowy middleman gets to decide what medications are “allowed” and how much you pay. And you don’t get a say in any of it.
Three PBMs control nearly 80% of the market. They answer to shareholders, not patients. If a drug company wants their product on the PBM’s preferred list, they have to pay to play — and guess who ends up footing that bill?
Brand-Name Manipulation & Generic Games
You’d think generic meds would be a silver lining — same formula, lower cost. But the pharma industry knows how to play the long game.
Instead of letting patents expire, they tweak a formula slightly, rebrand the drug, or simply flood the market with PR around the “superior” branded version. Doctors, under pressure from pharma reps, may continue prescribing the expensive version, even if the generic works just as well.
And if you think this system rewards innovation? Think again. Many companies spend more on marketing than they do on R&D. Some even buy small startups with real innovation just to bury the product and protect their existing cash cows.
Cures? Not profitable. Chronic conditions? That’s a subscription model.
Doctors Mean Well — But the System Doesn’t Let Them
Here’s the hard truth: most doctors get into medicine for the right reasons. They want to help. They want to heal. But the system they’re trained in jades them early — and limits them deeply.
They go to med school, not health school.
Most are trained to diagnose, prescribe, and refer. Not coach, support, or lifestyle-modify. Their education is dense in pharmacology and pathophysiology — not movement, not nutrition, not behavior change. And the research they rely on? It’s often funded by Big Pharma, Big Soda, or food industry giants, all of whom have a vested interest in keeping the cycle going.
So when we say “follow the science,” we also have to ask:
Who’s funding that science? And who profits from the outcome?
Most physicians aren’t being malicious. They’re being funneled down a narrow path where drugs are the only real tool they’ve been trained to use — and they’re expected to fix lifestyle-driven diseases with that tool alone.
And here’s the kicker: even when a doctor wants to do right by the patient, to explore lifestyle and behavior change, there’s often no one competent in the fitness industry to hand that baton off to.
That’s the other side of the problem. Medicine isn’t equipped for lifestyle intervention — and fitness isn’t equipped to support medicine.
At least, not yet.
A Pill for Everything — Except Real Health
There’s a pill for high blood pressure, high cholesterol, blood sugar, anxiety, inflammation, and poor sleep.
But most of those symptoms are also manageable — even reversible — through movement, nutrition, stress management, and better sleep hygiene.
So why aren’t those the first-line treatments?
Because there’s no insurance reimbursement code for “client stuck to their macros and hit 8,000 steps a day.”
There’s no prescription drug company sending out reps with gift cards for teaching someone how to deadlift properly.
It’s easier to prescribe than it is to coach.
It’s easier to manage than it is to heal.
The Real Cost
This isn’t just a rant. This is what your clients, your family, and maybe even you are dealing with. Burned out, confused, over-medicated, and under-coached. And worst of all? Taught to believe that’s normal.
It’s not.
We need systems that don’t just put a band-aid on dysfunction. We need providers, coaches, and educators who give a damn about why someone is broken — not just how to suppress the symptoms.
And if the healthcare system won’t lead that charge… we will.
We might be small in the grand scheme of this machine. We might not fix the system on our own. But we can expose the truth — and help people take back control of their health.
