This may sound counterintuitive, but the best place to start a path to Universal Healthcare is with big companies.
Our biggest companies are really bad dealing with the economics of their healthcare benefits. They get ripped off. A lot. They are not functionally set up to address both cost and quality of outcomes.
They take on all the cost risk. But. They hire companies affiliated with huge HC conglomerates to manage it all for them.
Those conglomerates keep the huge companies as much in the dark about actual costs as they do the 20 person start up
I can’t tell you how many times I have talked to companies with tens and hundreds of thousands of lives who had no idea whether the price the company administering their medical benefits paid a hospital for a surgery and in patient stay, was the same price they billed the company. They have no idea at all.
In many cases, they only receive a weekly invoice for millions of dollars for their medical and pharmacy benefits and they have no idea if it accurately reflects their contract, or, if they got the best price , or if there is a spread and more
Some try to audit, but the claims data doesn’t incorporate the actual amount paid to the care provider. Nor does it have all the fields necessary. Or even worse, sometimes they only get their weekly invoice and don’t have full claims available to them
Still, despite this they “ trust” these big conglomerates to act as middlemen and rip them off.
Why don’t they switch ? This is the conundrum they find themselves in.
They have tens or hundreds of thousands of employees and their families they cover. The law of big numbers say a lot of those folks are in very messy situations. They dont want to go through the pain, fear and uncertainty of moving from their current source of care. And the HR department knows the emotional switching cost of moving away from the incumbent is incredibly high. They don’t have enough people working in HR to deal with it.
Those same big companies rarely have more than one person acting as a “HealthCare CFO “, responsive for making sure all the pricing is accurate or negotiated.
And of course, no big company wants to admit they are getting ripped off. And none will violate their confidentiality clause of their contracts. I literally tell them to put a pdf of their HC contracts into their LLMs and just ask it “where am I getting ripped off “. Not perfect. But the list is always very long and eye opening
So what should they do. The word of the week is “Carve Out”.
These companies are big enough they can ask to Carve Out anything they want. I tell them to use their Carve Out to direct contract with transparent surgery centers and providers. Maybe just hop or knee replacements to start. Hopefully
CostPlusDrugs.com too :)
This is the starting point