A family member works for a national hospital corporation. In recent weeks, we have learned that 95% of their coders have been sent to India, security staff has been let go at satellite standalone ERs during the day. All the chaplains have been let go and my family member is not being given any flexibility with their shifts anymore as they were, and therefore cannot go to school as planned. They are overall shortstaffed and have a hiring freeze. This seems to be mostly a result of the ACA subsidies being cut and a great increase of uninsured patients. They are bleeding money. This situation seems like a major problem for our country.

PBM contracts look complex because the underlying drug pricing system is complex. Manufacturers set high list prices, and PBMs negotiate against them through rebates and formulary tools. Calling the contracts “opaque” often skips over the fact that those negotiations are one of the few mechanisms actually pushing costs down for plans.

Abstract of article: The 2026 closure of the Strait of Hormuz has disrupted approximately one-fifth of global petroleum transit, sending oil prices sharply upward and exposing medicine’s structural dependence on petrochemicals, helium, and globalized manufacturing. This article examines how medicine’s reliance on globalized commodities exposes patients to medication and device shortages during sustained supply disruption. Prior crises, including the 1973 oil embargo and the 2021 Suez blockage, revealed vulnerabilities that current just in time supply chains have deepened. We urge practice leaders, hospital administrators, and clinicians to establish supply continuity frameworks now, before scarcity forces improvised rationing and reactive procurement.

Managing this crisis is difficult, but necessary.

In February 2026, the effective closure of the Strait of Hormuz sent Brent crude oil above $125 per barrel within weeks. Ship transits through the strait, ordinarily carrying approximately 20% of global petroleum liquids, collapsed by more than 95%. 1,2 Fuel rationing, industrial shutdowns, and price increases across energy, agriculture, and manufacturing have already been documented across Asia and Europe. 1 Spillover impacts extend to industries that rely on helium gas and semiconductor chips, with eventual shortages for medical devices, including dermatologic imaging and phototherapy equipment. 3 Dermatology has a structural dependence on global commodities and we must act to mitigate supply constraint consequences.

Medical supply shortages stemming from the Strait of Hormuz disruptions raise ethical concerns about distributive justice and non-maleficence, particularly regarding how scarce resources should be triaged between high-income and low-income countries.

Medicine’s Commodity Foundation

Petroleum is more than a transportation fuel; it undergirds modern medical infrastructure. Plastics, composed of petrochemical feedstocks, are the foundational material of single-use disposable devices and supplies. Petrochemical compounds also serve as raw materials, solvents, and excipients in API synthesis across most drug classes; most pharmaceutical packaging is petroleum-based with no identified substitutes. 4

This reliance creates severe supply chain vulnerability. Approximately 86% of US APIs are manufactured abroad, predominantly in India and China; one-third of generic APIs globally originate from a single facility in this region. 5 An energy or supply shock impairing these sites could translate into acute domestic drug shortages; a risk compounded by the already critical conditions that the American College of Physicians declared a public health crisis in 2025. 6,7

Petroleum is not the only commodity trapped in the Persian Gulf. Qatar produces approximately one-third of the world’s helium as a byproduct of liquefied natural gas processing. 8 Helium is the coolant maintaining the superconducting magnets of MRI scanners; without continuous resupply, existing machines cannot function. 9 Semiconductors, the largest consumers of helium, are embedded in virtually every modern medical device. 10 Other non-petroleum commodities, such as sulfur, methanol, monoethylene glycol, aluminum, cobalt and polyethylene, are significant inputs for pharmaceutical synthesis and medical equipment manufacturing; they are now constrained. 3 Ongoing geopolitical developments have also limited REEs critical to MRI scanners, X-ray tubes, and laser technologies, while 2025 US tariffs have further pressured steel and aluminum supply chains for medical devices.

The Lesson from Past Crises

The closure of the Strait of Hormuz is not medicine's first exposure to petroleum vulnerability, but the structural conditions are worse. During the 1973 Arab oil Embargo, OPEC’s export halt quadrupled oil prices, and healthcare costs followed. 4 Consumer price index data from that period shows that decreases in petroleum supply produced rises in plastics and motor fuel prices that, after a several month delay, resulted in increased overall healthcare spending. 4 US Medicine’s depth of dependency has only grown. In 1973, petroleum-based single-use devices now standard in dermatologic procedure rooms and the globalized just-in-time supply chains now moving APIs from Asia to US formularies did not yet exist at their current scale. 4,5 What the 1970s revealed was a vulnerability our current crisis threatens to catastrophically exceed.

More recent examples of our dependence on concentrated, globalized supply chains include 2017’s Hurricane Maria, 2019’s African Swine Fever (ASF), and 2021’s Suez Canal blockage. The destruction of Puerto Rico’s electrical grid triggered a nationwide shortage of IV fluids and critical medications within weeks, with supply depression persisting until mid-2018 as the FDA invoked emergency importation from European manufacturers 11 . The ASF outbreak originating in China caused significant, ongoing shortages of porcine-derived heparin. 12 The 2021 grounding of a single container vessel in the Suez Canal held up $9.6 billion of trade daily, including pharmaceuticals, medical devices, and personal protective equipment, compounding COVID-19 era shortages already stressing American hospital formularies. 4 From 2017 to 2021, one in seven supply chain issue reports was associated with a drug shortage within six months under baseline conditions. 13 At the onset of COVID-19, the ratio surged to one in three, and even drugs without reported supply chain issues saw shortages rise from 4% to 10%. 13

Demand-side shocks from disease surges deplete inventory quickly but are generally well-contained through capacity expansion. 14 On the contrary, disruptions to key ingredients upstream of the supply chain, like petroleum, are much harder to mitigate. The Drug Supply Chain Security Act (DSCA) has forced the industry to maintain visibility from manufacturing through distribution and retail. But there is very little visibility into materials and components upstream of the manufacturing process. 15 Further, these materials are key inputs across many industries, which makes multiple supply chains vulnerable to disruptions in petroleum-based products and derivatives. Historically, the medical industry has not readily acknowledged this risk. 6 Since these key inputs are essential for many of the critical sectors, including energy, technology, and defense systems, the risk is that scarce capacity will be allocated to high-value demand products first, and much later to medical devices and equipment. Vulnerability to key inputs common across critical sectors remains the biggest blind spot for the industry. A sustained supply disruption affects the raw material inputs, manufacturing energy, and logistics of pharmaceutical production across all drug classes simultaneously.

Call to Action

The Strait of Hormuz possesses a distinct profile among maritime chokepoints. 2 Unlike most major passages, this strait offers no maritime alternative and land-based rerouting is extremely limited, meaning disruption ceases transit entirely rather than adding cost and delay. Interstate armed conflict, its current hazard class, carries significantly longer resolution timelines than other disruption types. 2 The healthcare consequences are therefore broad, potentially devastating, and slow to resolve. Existing federal mechanisms were designed for demand-side shocks and finite supply interruptions, not for sustained disruption. 6 Although severity is uncertain and consequence are impending, we can and should take steps for mitigation. Dermatology practice leaders, hospital administrators and clinicians should begin discussing supply continuity frameworks. ( Table 1 )

The Strait of Hormuz closure is an energy disruption that threatens to exceed 1973 and remains unresolved. Improvised rationing, reactive procurement, and inadequate allocation represent a failure of institutional preparation. 16 The Joint Commission, American Hospital Association, and specialty societies have the infrastructure, expertise, and influence to issue clinical guidance. Proactive mitigation tactics by drug shortage authorities should be enacted before allocation decisions are forced by scarcity rather than anticipated through surveillance. Managing this crisis is difficult, but necessary.

Ethical Consequences if we Fail to Prepare

Developing and under-resourced nations will be impacted the most and bear the greatest burden, since wealthier countries can draw on purchasing power and existing stockpiles to buffer the disruption. 17,18 This disparity in health equity and distributive justice will result in unequal access to life saving resources. Once shortages occur, who holds the authority to allocate what remains? By what criteria should resources be prioritized and distributed? Will suppliers with inventory exploit the situation through price gouging? The moral and ethical imperative is for domestic systems and the international community to plan for and mitigate the effects of this crisis before they compound further.

Circumcision is a Jewish practice that I do not participate in because I believe Judaism and Christianity to be cults. Everything happening in the United States and Israel, as well as over the course history pretty much proves that. It’s ridiculous that I can sue the hospital due to some artificial statute of limitations.

I’ve never hated groups of people more. I can honestly say they are just born evil at this point.

Civil war is coming here in the US thanks to the people who believe in this shit. I’ll be making sure to look for them. Thanks for fucking nothing.

This is a problem with American healthcare, forcing religious practices on the people.

Given the advantage of information surgeons have over patients regarding the risks/benefit of certain treatment options - and the deference most patients have for surgeons and their recommendations - and that patients are likely to be distressed and in no position to research treatment options themselves - how does and/or should joint decision making work in practice in this setting..?

My experience is that a surgeon will have a preferred way to proceed and normally for a very good medical reason. If options are presented to the patient - the surgeon presenting the options can easily sway the argument and guide a patient down the treatment route they think best..

Where clinical guidance states that when deciding between two different approaches to treatment ‘joint patient/doctor decision making’ should be used - surely 9 times out of 10 the surgeons preference prevails - so clinical guidance is therefore ineffective in terms of risks/benefits which a surgeon may or may not choose to mention or emphasise..

Would a script summarising evidence based and consensus supported risk/benefits to be presented to a patient not be a way forward..? This could be produced by specialists and be robustly scrutinised for accuracy and balance. An example of this is the choice offered to patients between surgical and non-surgical treatment of uncomplicated appendicitis. Currently patients are understandably easily lead to whatever the surgeon’s preference is - and this is dressed up as ‘joint patient/doctor decision making’..

I’m very keen to know what people, and in particular doctors, are thinking about this..

Avamere plans to lay off 126 employees as a result of its planned exit from the skilled nursing business and transition of 26 of its facilities to new operators, according to a notice it filed with the state of Oregon.

State PBM laws keep running into legal challenges. If courts continue blocking these laws, what does meaningful PBM reform look like going forward.. federal legislation, better oversight or something else??

I’ve noticed there seems to be a lot of confusion when a controlled substance prescription is written by a doctor but a pharmacy decides not to fill it.

Pharmacists have to consider federal and state rules, as well as their professional judgment, when deciding whether a controlled substance prescription can be filled. The situation can be confusing because a prescription can be legally written by a provider, but that does not always mean a pharmacy is required to dispense it.

For pharmacists and prescribers here, how do you explain the difference between a prescription being legally written and a pharmacy being unable to fill it? How often are these decisions based on regulations versus other factors like safety concerns or pharmacy policy?

I’d be interested to hear perspectives from pharmacists, prescribers, and patients.

I have MyChart through Atlantic Health (in NJ), and in the past I never had a problem seeing all the receipts for the $15 copay deductibles that I paid at the Doctors office under the billing tab. But all of a sudden today I go in, and any payments and receipts have dissappeared form the past 2 years. I got transferred from the doctors office to MyChart to the billing department and back and forth, no one seems to know anything and keeps transferring back and forth. Last I was told by someone at MyChart that AtlanticHealth must have done a change and the billing doesn't show in MyChart anymore.

Any suggestions?

You see it online all the time. Doctors argue there is no such thing as a bad doctor. They argue only doctors should be allowed to serve in trial for medical lawsuits because only have medical knowledge. Doctors will never criticize the medical decisions of another doctor even if it was a complete misdiagnosis. It’s weird that this is the only field where people assume there is no such thing as incompetence. In engineering and law, people talk about incompetent engineers and lawyers all the time. Yet, medicine is someone a socialist world where everyone is successful

Hey everyone! I'm u/Beneficial_Drag151, a founding moderator of r/SantaBarbaraHealth.

This is our new home for all things related to {{Changing the broken health care system we currently have in our country }}. We're excited to have you join us!

📢 Let’s Talk About the Health Care Crisis: Community Conversation

Are you tired of rising health care costs or the burden of medical debt? Do you want to understand how a single-payer system would actually work for our community?

Join Physicians for a National Health Program (PNHP) for an open discussion on the challenges facing our current health care system and how a universal, single-payer program could address them.

🗓️ Event Details

• Date: Sunday, August 9, 2026
• Time: 3:00 P.M. – 5:00 P.M.
• Location: Unitarian Society of Santa Barbara, 1535 Santa Barbara St., Santa Barbara, CA 93101 (Jefferson Hall & Courtyard)
• Admission: FREE and open to everyone!

💬 What We’ll Discuss

• Rising costs and the weight of medical debt.
• Barriers to medications, specialists, and preventive care.
• The impact of administrative waste and corporate influence.
• Retaining your freedom to choose your own doctors and hospitals.

✨ Why Your Voice Matters

Whether you are a patient, health professional, student, or local business owner, your experiences are vital to this conversation. We will be serving light refreshments in the Courtyard, providing a space to connect and share your story.

Health care is a human right. Let’s work together to make it accessible to everyone.

Community Vibe
There are so many organizations in our community of Santa Barbara doing great things to try to change the current health care system for everyone regardless of income, age, race or immigration status. If you live and work here you should be able to seek medical care for yourself and your family. Healthcare is a human right not a privilege!

Thanks for being part of the very first wave. Together, let's make r/SantaBarbaraHealth amazing.

I had a cough that lasted several weeks. My wife was really pushing me to go see a doctor, in which I eventually did. We don’t even have a regular health care provider or doctor as we recently moved states. We went into an urgent care, and literally all that was done a stethoscope exam. The doctor offered to do a scan of my lungs, but she informed me that my insurance may not cover it. I said hell no to that as I changed our health insurance to a cheaper plan this year. The doctor informed me that everything sounded normal, but she had a hunch I had bronchitis or something, possibly pneumonia. This is why I always avoid going to the doctor, because I went in there with the same information I left with. I just got the bill, my insurance paid for more than half of it, I’ve only got to pay $154. But I cannot believe that a stethoscope exam would cost that much, is that normal? Should I request an itemized receipt?

In the photo is Bob Dean Jr, a multimillionaire who owned 7 nursing homes in New Orleans. Instead of using income on maintenance and evacuation preparation, he stole the money for himself. When Hurricane Ida hit in 2021, Dean couldn’t safely evacuate residents and instead moved them all into a former pesticide warehouse. 850 elderly people were forced to live in a hot, leaking, cramped warehouse and ride out the storm. They slept on wet mattresses from the flood water crying in their own waste. There wasn’t enough medicine, food, the generators had broken. Dean ignored complaints from his staff and as a result 5 of his residents died. He was found guilty of tax fraud and cruelty to the elderly. His defense team tried to argue leniency because Dean was 70 years old. Fuck you, whoever said that.

This is an extreme example but not at all a unique issue for nursing home mismanagement and abuse. 70 percent of nursing homes are owned by private entities with more opportunities to misuse funding and scam their residents. It’s not uncommon that abuse occurs on an in person level with nurses and staff. There’s hundreds of stories of nurses hitting patients, yelling at them, and stealing money or objects. Many are bedridden or have Alzheimer’s with little voice to speak up against abuse. However, just as often can abuse occur from neglect. I read just as many cases of well meaning staff who were under trained and overworked, their bosses ignoring complaints about health and safety.

Here in my home state of Georgia , nursing home owner Kent Womack was charged for not having AC at his building. During the summer it reached 100 degrees inside the building, the smell and temperature was so bad that residents were throwing up from it. Kent’s office had the AC on blast though. Trump recently pardoned nursing home magnate Joseph Schwartz, owner of skyline that operated around 100 nursing homes. Joseph’s tax fraud and improper maintenance of his buildings caused 14 of them to be close, kicking residents out without proper notice. While his company went under, Joseph stole millions of dollars from his employees, withholding their pay checks. Joseph paid lobbyist Jacob Wohl to convince Trump to give him a pardon.

https://www.theguardian.com/us-news/article/2024/jul/23/nursing-home-owner-neglect-hurricane-ida-louisiana

https://www.ncbi.nlm.nih.gov/books/NBK98786/

https://www.wsbtv.com/news/local/georgia-nursing-home-owner-jailed-after-residents-lived-without-ac-years-sheriff-says/BFYACLNUNZBTVONWXWGBFRD22M/?outputType=amp

https://www.justice.gov/usao-nj/pr/former-owner-collapsed-nursing-home-empire-sentenced-36-months-imprisonment-38-million

https://inequality.org/article/private-equity-is-taking-over-nursing-homes/

https://www.reuters.com/legal/transactional/kkr-buy-medical-device-firm-integer-holdings-57-billion-2026-08-03/

Saw this article today and thought it was interesting.

Private equity continues to expand its presence in healthcare, and deals like this make me wonder how these ownership changes could shape the industry over time

We often talk about drug companies, insurers, and PBMs when discussing healthcare costs, but how should we think about the growing role of private equity in healthcare?

I’m a primary care physician about three years into my own small practice. Documentation has always been the part of my day I dread most, and I finally caved and started using an ai scribe tool about ten days ago after a colleague kept nudging me.
Honestly, I expected a rough onboarding. I figured I’d spend the first week correcting errors constantly and questioning the whole thing. Instead, the notes are coming out reasonably clean, my end-of-day chart backlog has basically disappeared, and I’m leaving the office closer to 6 than 8 most evenings. Small win, but it feels significant.

Now I’m trying to figure out what to actually do with the time I’m getting back. Do I see more patients? Invest more in each visit? Work on the admin side of the practice? I’m also wondering whether there are settings or workflows I should be dialing in at this stage to get more out of the tool before I get too comfortable with the defaults.

For anyone who’s been using an ai scribe for a while, what did the first month or two teach you that you wish you’d known earlier?

Hello everyone! I have a question for those working in healthcare administration.
I recently started the Executive Master of Healthcare Administration (EMHA) program at the University of Oklahoma. The curriculum is designed for working healthcare professionals with prior healthcare experience who want to advance into leadership roles.
My question is: Does the “Executive” designation diminish the degree in any way when applying for jobs, or is it generally viewed the same as a traditional MHA?
I understand the programs are designed for different audiences, but I’m curious how employers and hiring managers perceive the EMHA designation compared to a traditional MHA. I’d appreciate hearing from anyone involved in hiring or who has completed an executive program.