297: Insurance Rigged Against You - with Chris Hamilton

Health insurance in America is expensive on purpose, not by accident. Chris Hamilton argues that confusion and hidden incentives are the real products big carriers sell… and employers and employees pay the price.

How Insurance Giants Game the System

Under federal rules, large insurers in the USA can only keep about 15 percent of premiums as profit, which sounds protective until you realize it pushes them to grow the total cost of care. To do that, they've built a "massive ecosystem that's able to bill the insurance company" by buying physician groups, pharmacies, and pharmacy benefit managers and capturing "hidden profits in these subsidiaries." As Hamilton puts it, "We're overpaying, they're overbilling," yet premiums still go up and "the value's being captured and retained for shareholders… not for the public good."

The Human Cost is Staggering

Hamilton's brother, insured by a Fortune 500 company, was hospitalized 26 times in four years, hit his out-of-pocket maximum every year, and ended in medical bankruptcy… "but he had insurance." Meanwhile, a mid-sized employer a mile and a half away offered free health insurance and a direct hospital deal so those same hospitalizations could have cost him nothing out of pocket, proving that two companies can both "offer health insurance" and deliver completely different outcomes.These are not isolated incidents. 

You're Already in the Insurance Business

Hamilton's core message to leaders is blunt: if you're spending millions on benefits, "you're in the health insurance business," whether you admit it or not. Future-proofing starts by moving away from one-size-fits-all, fully insured plans and into a partially self-funded model where you see your data, choose your partners, and "align the incentives of everybody that's involved."

Build a Plan That Works

That can include direct contracts with high-value hospitals, concierge or direct primary care for everyday needs, and navigation support so employees choose higher-quality, lower-cost options… often at zero cost to them and lower cost to you. Done right, a health plan stops being a runaway liability and becomes "a really big asset in the recruiting and retention process." The goal is simple: stop overpaying into a system designed to confuse you, and build one where transparency, outcomes, and incentives finally line up.

In this podcast you'll learn:

• How insurance companies exploit the 15% profit cap to drive up total healthcare costs

• Why two employees with "insurance" can face wildly different financial outcomes

• The self-funded alternative that gives you control over data, costs, and quality

• How to turn your health plan into a recruiting advantage instead of a runaway expense

 

EPISODE RESOURCES:

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