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To add to Ragen's outstanding analysis:

The gold standard of insurance approvals is to get CMS to approve a drug for Medicare/Medicaid patients. Most insurance companies base their standard practices on what CMS does with these groups.

Medicaid is problematic because most of its insureds are poorer, and Medicaid monies are more limited and are monitored very tightly by the states as well as the Feds. Too much trouble for the profiteers.

But Medicare's constituents are the elderly (so, everyone eventually, if we are lucky) and the disabled. And so we see the weight loss industry pushing interventions at the very old, just like the very young. Major medical institutions like the Cleveland Clinic and Hopkins bang the drum loudly about the dangers of we-know-what way past the age when studies show that *any* kind of weight loss, even intentional, increases mortality.

Cleveland Clinic is the medical advisor for AARP.

And as for the disabled, well, what a target group. If you can make o*es*ty itself a qualifying disability, we'll that's a gold mine of a market. But even if not, the more you can make it "causal" or at least "contributory" in other disabilities, the more pressure you can put on CMS.

Ironically, some of our best friends in *this* battle are the insurance companies. They don't want to be on the hook for universal, expensive weight loss drugs and surgeries. So we have groups like the OAC suddenly becoming friendly social justice warriors who try to leverage people's everyday distrust of insurance companies into an unholy alliance (trust *us* to help you) that could open the doors to trillions of dollars for them.

Oh and bust Medicare by the way.

Big picture indeed.

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