A breast cancer drug in South Africa costs $38,000 per year. The average household income? $7,500. That's five times what an entire family makes annually.

In the U.S., Gilead's hepatitis C cure hit the market at $84,000 per treatment course. Production costs? Estimated in the hundreds of dollars.

This isn't a story about greedy corporations or evil pharma executives. It's about incentive structures—and how they shape who gets access to life-saving medications and who doesn't.

In this solo episode, host Noah Volz zooms out from Southern Oregon to examine the global pharmaceutical pricing system that determines what medications are available locally—and what they cost. Even the most innovative community healthcare models hit a ceiling when drug prices consume entire budgets.

You'll discover:

• How pharmaceutical companies shift $112 million annually in profits to tax havens (while governments lose funding for clinics and vaccination programs)
• Why profit margins exceeding 20% are common in pharma when most industries operate at 5-10%
• What TRIPS patent protections actually do (hint: they create legal monopolies that prevent generic competition for years)
• Why the 2001 Doha Declaration said public health should override patents—but countries still can't access affordable generics
• How the Health Impact Fund would flip incentives from "charge maximum price" to "create maximum health outcomes"
• Why drug pricing affects gender equity (unpaid caregiving falls overwhelmingly on women when healthcare becomes unaffordable)
• The ceiling community healthcare innovations hit when upstream pharmaceutical pricing extracts all available resources

This episode is for you if:

• You've seen medication costs wipe out family budgets and wondered why prices are so disconnected from production costs
• You care about healthcare innovation but question whether current incentives serve public health
• You've followed this podcast's focus on Southern Oregon and want to understand the global forces limiting local solutions
• You believe structure shapes outcomes and want to see how that principle applies to pharmaceutical pricing
• You're tired of "pharma is evil" takes and want actual analysis of how incentive systems work

Why this matters for Southern Oregon: Jackson Care Connect, AllCare, and La Clinica are doing remarkable work—investing in prevention, housing, social determinants. But when medication costs consume disproportionate budgets, those preventive investments get overwhelmed. You can optimize local healthcare delivery all you want, but if upstream incentives extract value rather than create health, there's a ceiling on what local innovation can achieve.

The core insight: Pharmaceutical companies aren't irrational or evil—they're responding to incentives the system creates. Patent monopolies reward high prices. Tax structures enable profit shifting. Research focuses on profitable conditions in wealthy markets. Change the incentives, change the outcomes.

No prescriptions. No easy answers. Just clarity about how the system actually works—and why understanding incentives matters more than assigning blame.

Here's a question most people never ask: When you pay your medical bills, where does that money actually go?

Shareholders in New York? Private equity investors cashing out in 3-5 years? Hospital executives with multi-million dollar compensation packages?

Or does it stay in your community?

The thing nobody talks about—might be the most important factor shaping your care. Using AllCare Health in Southern Oregon as a case study, he shows how a physician-owned structure creates completely different incentives than corporate healthcare.

You'll discover:

• Why 76% of doctors owned their practices in 1983, but less than half do today (and what that shift means for you)
• The legal trick that lets AllCare prioritize long-term community health over quarterly profits (it's called Benefit Company status—and it changes everything)
• How physician-owners make different decisions when they'll see the results in their own exam rooms next month
• Why preventive care programs make zero sense to shareholders but total sense to doctors who'll practice in the same town for 30 years
• The three ownership models dominating American healthcare (and why most people don't realize there's a fourth option)
• What happens when surplus healthcare dollars get reinvested locally instead of flowing to distant investors

This episode is for you if:

• You've ever wondered why healthcare decisions seem disconnected from what patients actually need
• You're choosing health insurance and want to understand what really matters beyond premiums and deductibles
• You're tired of corporate consolidation but assumed that's just how healthcare works now
• You're a clinician feeling pressure to sell your practice and want to know there are alternatives
• You believe structure shapes incentives, and you want to see the receipts

No jargon. No corporate speak. Just a straight conversation about who owns the system making your healthcare decisions—and why that ownership determines almost everything else.

The uncomfortable truth Noah shares: Most healthcare reform focuses on treatments, technology, or payment models. But if ownership incentivizes quarterly profit over long-term health, all those reforms hit a ceiling. Change the ownership structure, and suddenly different decisions become possible.

Why this matters beyond Southern Oregon: While private equity investment in healthcare approaches $1 trillion and physician ownership hits historic lows, AllCare proves alternative models can work at scale ($472M annual revenue, 70,000 patients). This isn't boutique medicine for the wealthy—it's a different way of structuring mainstream healthcare.

The episode connects directly to previous discussions of Jackson Care Connect and housing-as-healthcare, showing how ownership structure enables the community-focused investments other episodes explored.

One question to ask yourself: Next time you interact with healthcare—picking a plan, choosing a provider, navigating insurance—ask: Who owns this system? Where does the money go? Who benefits when decisions get made?

That question cuts through a lot of noise.

Listen if you want to understand: Why healthcare often feels like it serves someone other than patients (because it often does—the ownership structure tells you who), what alternatives exist beyond corporate consolidation, and how to evaluate healthcare organizations based on incentives, not marketing.

No prescriptions. No sales pitch. Just clarity about how ownership shapes the system everyone's trying to navigate.

Your fatigue is real. Your insomnia is legitimate. The blood work says you're fine, but you know something's wrong. Your doctor suggests you "try to relax more" and sends you home with a generic stress management pamphlet.

Sound familiar?

Research shows that up to 70% of primary care visits have behavioral health components—anxiety presenting as chest pain, depression manifesting as chronic fatigue, stress sabotaging diabetes management, trauma hiding behind unexplained physical symptoms. Yet American healthcare treats your mind and body like they live on different planets, forcing you to navigate separate systems that never talk to each other.

Until now.

La Clinica Health Center in Southern Oregon has embedded behavioral health professionals into every aspect of primary care—not as a separate department you get referred to, but as part of your medical team from day one. Across 29 locations including 19 school-based clinics, they're proving that integrated care isn't just better for patients—it's the only approach that actually makes sense.

This episode is for you if:

• You've ever felt dismissed when physical symptoms had no clear medical cause
• You've tried to find a therapist and given up after weeks of calling offices that aren't accepting new patients
• You're managing a chronic condition and suspect stress is making it worse, but your doctor doesn't have time to discuss it
• You're a parent watching your child struggle emotionally but can't figure out how to get them help
• You believe mental and physical health are connected and are tired of a healthcare system that pretends they're not

The uncomfortable reality: Most primary care doctors know behavioral health affects their patients' physical health. They just don't have the tools, training, time, or team to address it. La Clinica proves it's not about individual doctors working harder—it's about redesigning the care team itself.

Why this matters beyond La Clinica patients: When 19.9% of behavioral health needs go completely unmet nationally, and when mental health crises drive expensive emergency room visits, La Clinica's model offers a blueprint. The Behavioral Health Fellowship training new clinicians will spread these practices throughout Southern Oregon and beyond—proving that integration isn't a luxury for wealthy systems with unlimited resources, but a practical necessity for rural communities with limited mental health specialists.

Resources mentioned:

• La Clinica Health Center: laclinicahealth.org/services/behavioral-health-services
• La Clinica Main Line: (541) 535-6239
• The Learning Well (wellness education and support)

Healthcare doesn't happen in compartments. Your body doesn't separate physical from mental, so why does your healthcare system? Listen now to discover what care looks like when a clinic finally treats you like the whole person you actually are.