Chapter 654 - 305: The View from the Top

In the command center on the top floor of Pittsburgh City Hall, a long-absent sense of ease filled the air.

On the massive LED screen, the red alert line that once signified the fiscal deficit had vanished, replaced by a stable green curve.

Blake Finch stood before the screen, the tapping of his calculator finally ceasing.

The balding director of the budget office let out a long breath, as if a thousand-pound weight had been lifted from his shoulders.

"Mr. Mayor, the numbers are balanced."

Finch turned around.

"Not only are they balanced, but we’re even starting to see a surplus. Ever since the trust fund officially took over pharmaceutical procurement, our drug acquisition costs have plummeted by forty percent."

"City Hall no longer has to dip into the city’s treasury each month to plug the healthcare deficit. That money can now be used to repair roads or pay police officers for overtime."

Leo Wallace sat in the command chair, a glass of ice water in his hand.

He watched the flickering numbers on the screen.

This was the monetization of power.

He had used the knife of legislation to slice open the veins of the pharmaceutical giants, forcibly cutting off the profits that once flowed to Wall Street.

Evelyn Saint Cloud was sitting on a nearby sofa, looking through an actuarial report.

"Your methods are crude, Leo." Evelyn closed the report, a satisfied smile playing on her lips. "But I have to admit, they’re extremely effective."

"Although you’ve capped Penn-PBM’s profit margins, they’ve monopolized the entire procurement channel for Pennsylvania. Even with high volume and low margins, this quarter’s financial report is shockingly good."

"It’s a win-win,"

Leo said nonchalantly.

"You made money, the citizens saved money, and City Hall was relieved of its burden."

"The only ones who lost out are the middlemen who used to make money doing nothing."

Leo stood up and walked to the floor-to-ceiling window.

The Pittsburgh nightscape stretched out below him.

Families who once despaired because they couldn’t afford medical care now held Red Cards, their hearts filled with a newfound sense of security.

But he knew this peace was temporary.

He had made too much noise in Pennsylvania.

’Mr. President,’ Leo thought, ’what do you think they’ll do?’

"They will retaliate," Roosevelt’s voice echoed in his mind. "You moved their cheese, and a big piece of it at that. This is a quantifiable loss."

"In the world of capital, a quantifiable loss is a declaration of war."

...

「New York, Midtown Manhattan.」

The top-floor conference room of an unmarked skyscraper.

This was the secret headquarters of the National Association of Pharmacy Benefit Managers.

Three men sat around a circular table.

They represented CVS, United Health, and Express Scripts, respectively.

The representative from CVS threw a financial summary onto the center of the table.

"One-point-five percent."

His voice was ice-cold, laced with murderous intent.

"That was the drop in our profit margin in the Pennsylvania market last quarter. In cash terms, that’s about three hundred million US Dollars in net profit that just evaporated."

"That damn Leo Wallace, and that class-traitor bitch Evelyn Saint Cloud... The Rust Belt trust they cooked up completely bypasses our pricing system."

The representative from United Health loosened his tie, tapping his fingers on the table in irritation.

"The problem isn’t just the money."

"It’s the precedent it sets."

"Several industrial cities in Ohio have already sent people to Pittsburgh to investigate. And yesterday, a Union leader from Michigan was on TV publicly calling for them to follow the Pennsylvania model and establish their own health trust."

"This thing is a virus."

"If this model spreads across All of America, with every state starting its own purchasing alliance and using executive orders to force down prices, our business model is finished."

The representative from Express Scripts had been silent.

"We lost in Harrisburg," he said suddenly.

"We were utterly defeated on the legislative front. That young Mayor used public opinion to hold the legislature hostage, and even members of the Republican Party sided with him."

"Now, Pennsylvania law protects that trust. We no longer have any legal means to stop them there."

The Express Scripts representative continued, "Our mistake was trying to go it alone. We thought the power of the pharmacy benefit managers was enough to crush a single mayor."

"But Leo Wallace has grown. He holds executive power, legislative power, and that damn public opinion."

"To deal with an opponent of this caliber, we need allies."

"More powerful allies."

He picked up the phone on the table.

"The CEO of Pfizer isn’t asleep yet, is he? And get the people from Merck and Johnson."

"Call them."

The Express Scripts representative paused, his tone growing even colder.

"The Mutual Aid Alliance is now using its control over the entire Pennsylvania market to force smaller pharmaceutical companies to accept their draconian terms, and their profit margins are dropping too."

"If Leo’s power is allowed to expand any further, Pfizer will be the next one pinned to the ground and beaten."

"This is a war for pricing power over the entire healthcare industry chain. No one can stay on the sidelines."

...

The calls were connected quickly.

This was no longer a simple business rivalry; this was class warfare.

The pharmaceutical giants certainly understood that their fates were intertwined.

While the pharmacy benefit managers usually sucked them dry, they were also the firewall that maintained high drug prices.

If the pharmacy benefit manager system collapsed, the drug companies would have to directly face an angry public and a greedy government.

When that time came, price transparency would leave their patented drugs, with their markups of several dozen times, with nowhere to hide.

A massive alliance of vengeance, spanning the entire healthcare industry chain, formed swiftly in the dead of night.

But this wasn’t enough.

For the true upper echelon of capital, the loss of a few billion US Dollars was painful, but not enough to cripple them.

What truly terrified them was the logic behind Leo Wallace’s model.

「Wall Street, BlackRock Headquarters.」

In an office overlooking the entire financial district, a silver-haired investment director stared at the Bloomberg Terminal in front of him.

On the screen, the healthcare sector index was showing subtle fluctuations. The ratings for stocks related to the Pennsylvania region had been downgraded.

"He is destroying value," the director said to the team of analysts behind him.

"Do you all understand? This Mayor from Pittsburgh is using administrative means to eliminate premiums."

The director stood up, walked to a whiteboard, and drew a large circle.

"This is the greater healthcare capital pool."

"Within this pool, it makes little difference to us institutional investors whether the money is made by insurance companies, pharmaceutical firms, or even hospitals."

"Because we hold stock in all of these companies."

"The money just moves from the left pocket to the right. As long as the total pie is growing, as long as healthcare spending as a percentage of GDP is increasing, we profit by holding these assets."

The director’s pen slashed across the circle, cutting off a large piece.

"But what is Leo Wallace doing?"

"He’s cutting this piece of the profit out."

"Through price suppression and mutual aid, he is saving money that should have become corporate profit, the driving force behind stock price increases, and shareholder dividends."

"He’s giving that money to the voters."

"Giving it back to the poor who can’t afford to be sick."

The director’s voice turned icy.

"This means the total pool of capital is shrinking."

"For Wall Street, this is a pure loss."

"He is taking meat from our plate and feeding it to the lower class, who don’t generate capital growth."

"If this behavior is emulated, it will become a national trend."

"The entire valuation logic of the healthcare sector will collapse. Trillions of US Dollars in wealth will evaporate."

"This is a systemic risk."

The analysts listened to the director’s analysis, their expressions grave.

They had originally thought this was just a local political farce, but now they realized it was a challenge to the core value-add logic of capitalism.

"So what should we do?" the chief analyst asked. "Short Pennsylvania?"

"No."

The director shook his head.

"The little money we’d make from shorting won’t compensate for the loss from the sector’s decreased valuation."

"We need to solve the problem at its source."

The director picked up his phone.

He dialed a number that very few people knew.

It was a dedicated line to the deepest reaches of K Street in Washington D.C., to the super PACs that could decide the nation’s political course.

"This is Stephen from BlackRock."

"We need to talk about Pennsylvania."

"That young man, Leo Wallace, has crossed a line."

"He is a virus."

"He must be eliminated before he infects the entire system."

"At any cost."

...

「Pittsburgh.」

Leo stood at the window, looking out at the sleeping city.

He didn’t know that in distant New York and Washington, the noose targeting him was already tightening.

But he could feel it.

The kind of intuition honed through countless gambits.

The wind had changed direction.

"Mr. President," Leo said in a low voice.

"I can feel it."

"The big guys have finally turned their attention to us."

Roosevelt’s voice remained calm.

"It was inevitable, Leo."

"The ones you fought before were merely their proxies, their gloves."

"Now, you have touched their very being."

"You have upset the fundamental logic of capital growth."

"That’s worse than murdering their parents."

"Get ready," Roosevelt warned.

"The coming war won’t be about a single bill or a particular election."

"It will be about survival."

"They will use finance, the law, the media, and even the machinery of the state to crush you."

"Because you are trying to prove one thing: that the people can live well without them."

"To them, that is the greatest blasphemy."

Leo smiled.

He looked at the sea of lights outside his window.

"Then let them come."

"I’m no longer that student who had nothing."

"I have Pittsburgh. I have Pennsylvania."

"If they want a war."

"Then we’ll have it here, on the soil of this Rust Belt."

"We’ll see which is harder."

"Their US Dollar, or our steel."