If Everyone's Hurting, Who's Winning?

We built a healthcare system to deliver care—and ended up with one that delivers invoices, confusion, and gridlock instead. Every year, we throw more money at a system that delivers less: less clarity, less health, and less control. Everyone—hospitals, patients, and employers—is hurting.

And yet, the middlemen keep winning. If we’re being honest, we should all be asking: WTF gives?

Let’s break it down:

Hospitals—what are your biggest problems today? They’ll tell you:

• Endless billing complexity and ballooning revenue cycle costs.

• Chasing down reimbursements across dozens of payers.

• Prior authorizations and denials that delay or deny needed care.

• Payment delays that crush margins, burn out staff, and destabilize operations.

  
  

Studies consistently show that 25% or more of hospital revenue is eaten up by billing and insurance-related costs. In many cases, hospitals now employ more billing clerks than physicians. And when margins are (allegedly) razor thin—often in the 2–3% range and even lower for rural hospitals—this inefficiency can mean the difference between solvency and closure. Hospitals didn’t ask for a system like this. They’re forced to navigate it. And play the games that it requires.

Patients—what’s standing in your way? Try navigating this: You go in for a procedure you were told was covered. You checked your benefits, got your pre-auth, and paid your copay. Six weeks later, a $3,400 bill arrives from an out-of-network anesthesiologist. You call your insurer and get transferred four times. You don’t understand your Explanation of Benefits. You don’t know if you owe it, and if you do—you don’t know why.

This isn’t rare. It’s routine. Studies show that 72% of patients are confused by their medical bills. Only 4% of Americans can correctly define their deductible, coinsurance, copay, and out-of-pocket max. Many delay care because they fear the financial fallout more than the diagnosis itself. That’s not just poor design—it’s institutionalized harm.

Employers—what are you frustrated with? Where do we begin?

• We’re told we’re the plan fiduciaries—but denied access to the contracts we’re bound by.

• We fund the plan, but can’t audit the discounts, overrides, or spread pricing.

• We’re legally on the hook, yet forced to act like passive bystanders when double-digit rate hikes land on our desks with no justification and no real ability to negotiate.

  
  

Let’s not forget: we are the purchasers. We fund this system—public employers, private employers, union plans, self-funded ERISA plans. And yet we are structurally locked out of oversight. We’re expected to “manage” benefits without access to claims detail, pricing data, or even the full set of third-party contracts that govern our spend.

If any other CFO signed a multi-million-dollar contract they weren’t allowed to review or audit, they’d be fired. In healthcare, we call it business as usual.

And here’s the thing: everyone is suffering.

• Hospitals are bleeding money into administrative bloat.

• Patients are drowning in bills and confusion.

• Employers are footing the bill for a system they can’t control.

  
  

So again: WTF gives?

The answer lies not in the hospitals. Not in the patients. Not even in the employers.

It lies in the middle.

PBMs, legacy TPAs, incumbent intermediaries, network administrators, repricers, opaque tech stacks, rebate managers, and yes, even some audit and bill review firms—they’ve grown fat off a system that was supposed to help, but now exists to sustain itself.

Let’s be fair. Some of these players have a role today—because we need them to clean up the mess that the current system creates.

But imagine a future where we didn’t. Where:

• Doctors are paid directly and fairly for the care they deliver.

• Employers have transaction-level data in real time.

• Patients understand what they’re getting and what they’ll owe.

• Contracts are visible. Payments are direct. Waste is gone.

  
  

That’s not utopia. That’s possible. But only if we stop defending the outdated machinery that clogs the gears.

Let’s stop pretending this model still serves us just because it once had a reason to exist. Intermediaries were born in an era of paper claims, siloed systems, and static networks. But today? Technology, transparency, and data interoperability can deliver cleaner, faster, and fairer care—without the need for layers of rent-seeking intermediaries.

We can pay providers more than fairly. We can fund the innovation that keeps doctors practicing and hospitals thriving. And we can return savings to patients and employers—all while radically simplifying the experience.

Let’s return to the basics:

• Purchasers buy.

• Providers care.

• Patients benefit.

  
  

And in between? As little as possible.

There are solutions that exist in the market now that can show what’s possible when we remove the noise and reconnect the real parties in healthcare: patient, purchaser, provider. Not by tweaking the margins—but by rebuilding the model.

It’s not rocket science. And even if it were—my third grader built a rocket out of a plastic bottle and vinegar last month. Simpler systems can still do extraordinary things. We just have to stop overengineering failure.