How to Curb Profiteering and Reclaim True Value (feat. Wendell Potter)
TRANSCRIPT
Click here to listen to the episode, published March 31, 2026.
JOHN: Thank you all for joining us today for another episode of our podcast, Moving to Value Unscripted. My name is Dr. John Rodis, and I'm a recovering ex-hospital president and am proud to be the president of the Moving to Value Alliance. The Moving to Value Alliance, a 501c3 nonprofit, is a multi-stakeholder grassroots organization whose purpose is to foster a community that aims to create a value-based healthcare ecosystem with high-quality outcomes at a reasonable cost for plan sponsors and their members, beneficiaries, or employees. I want to thank our members who support makes this podcast possible. We'd like to give special recognition today to our trade member, Connecticut Joint Replacement Surgeons, LLC. I'm joined by my fellow board members, Dr. Steve Schutzer, Lisa Trumble, Kim Lynch, and Donovan Pyle.
STEVE: Yeah, I'm Dr. Steve Schutzer, orthopedic surgeon, co-founder of the Moving to Value Alliance. I'm also co-founder and chief medical officer of Upswing Health, a national virtual orthopedic company focused on improving patient access, clinical outcomes and value in MSK care.
LISA: And I'm Lisa Trumble, president and CEO of Southern New England Healthcare Organization based here in Windsor, Connecticut, a physician-led clinically integrated network focused on population health and value-based care in both Connecticut and Massachusetts.
KIM: I'm Kim Lynch, founder and CEO of Metis Health Technologies, where we help clinicians and healthcare organizations streamline operations, increase revenue, and deliver better patient care. I'm originally from Michigan, now based in DC.
DONOVAN: I'm Donovan Pyle, founder and CEO of Health Compass Consulting in Orlando, Florida. I'm the author of a book called Fixing Healthcare, How Executives Can Save Their People, Their Business, and the Economy, and I chair the Validation Institute's Certified Health Value Professional designation.
JOHN: Our guest today is Wendell Potter, editor-in-chief of the HEALTH CARE un-covered newsletter and president of the Center for Health and Democracy. Wendell has been called the ideal whistleblower by TIME Magazine. For two decades, he sat at the highest levels of the American healthcare machine as a senior executive at insurance giants like Humana and Cigna. He was an architect of messaging that defended the status quo of a system built on volume rather than value. His career took a dramatic turn after a crisis of conscience. In 2009, he testified before the U.S. Senate as a whistleblower, exposing how insurance used purging and spin to prioritize shareholder returns over patient outcomes. He has since dedicated his career to pulling back the curtain on the industry. Wendell is the New York Times bestselling author of books Deadly Spin and Nation on the Take. Through his HEALTH CARE un-covered newsletter, he exposes the tactics used by insurers, pharmacy benefit managers and third-party administrators to inflate costs. We're so excited to have Wendell on to discuss his work decoding the healthcare industry's black box. Welcome to Moving to Value Unscripted, Wendell.
WENDELL: Thanks, John. Good to be with you all.
JOHN: So Wendell, let me start by asking, as a president of a hospital, it took me a little while to figure out that I was part of the problem or I'm the part of the solution. And it sounds like somewhere along the way you had that same epiphany. So I'm kind of curious about what is it, did something happen? Was there an event, a single person, a patient? What kind of made you start realizing that, wait a minute, we are part of the problem?
WENDELL: You know, I appreciate the way you phrased that question because throughout my career, I was trying to make sure that people believe that big health insurance companies were part of the solution, not part of the problem. And I ultimately came to believe that that was not true. I had been believing my own PR, if you will. I began to change my beliefs around the time, well, a couple of years before I left. I was among those in the industry that was expected to help usher in an era of what we referred to as consumer-driven healthcare. And I came to realize that the way that my companies, the companies that I worked for and the industry were viewing that was really just a way to shepherd people as fast as possible into high deductible plans to offload claims that they had been paying in the past to people enrolled in their health plans. And I knew that this was not going to be something that was going to be good for people with chronic conditions or people who didn't have a lot of money to spend out of pocket what their insurance company wouldn't cover before their coverage kicked in. I went to visit my parents. They were still alive at this time. This was 2007. I went to visit them in Kingsport, Tennessee, where I grew up. And I read something in the newspaper about a healthcare expedition being held at a nearby county fairground. I was curious. The story said that people would be driving from hundreds of miles away to get care there. It was a charity event put on by an organization called Remote Area Medical, which I'd never heard of at that time. And I went out of curiosity. And I've often said that that road between Kingsport, Tennessee and Wise, Virginia, where this county fairground was, just a little bit across the state line, was my road to Damascus. When I got there and walked through the fairground gates, I just couldn't believe that I was still in the United States of America. I saw people who were lined up by the hundreds there in many lines, and they were soaking wet because it had been raining that morning. This was outside. And I quickly realized that a lot of those lines led to barns on that fairground site and to animal stalls that volunteers had worked in the days before to clean up to convert to examining rooms.
JOHN: Wow.
WENDELL: It was stunning to me to see what was happening. I had a job that essentially protected me from the realities of healthcare and how so many people experience it in this country. And I realized too, well, I was told later by the organizers that a lot of those people who were in those long lines had health insurance, but they couldn't afford their deductibles or their co-insurance or co-pay.
JOHN: Yeah, yeah.
WENDELL: It was stunning to me. And I made a decision that day that I would have to earn a — find out some other way to earn a living, that I was part of the problem. I had to accept that that day, that I was part of the reason those people found it necessary to get care in animal stalls.
JOHN: Wow. I always wondered why we call it insurance. It's not insurance, it's more bookmaking. You know, you give, they take the money from people and they give a little bit money out and they keep a little bit from the sale. So it seems much more like that. And that's not really — the way I think of insurance as life insurance or homeowner's insurance. Well, thank you for that.
STEVE: Yeah. Hey, Wendell, you know, I think our friend Stacy Richter maybe said it, and I heard it — there are no pure angels nor pure devils in healthcare today. And I remember 20 years ago, I read three books from the Harvard Business School. One of them was called Who Killed Health Care? I don't know if you read that by Regina Herzlinger.
WENDELL: Yes, yes.
STEVE: And that was a turning point for me because I don't like pointing fingers at any one stakeholder because we all have a finger in it, right? So I have a hard time just strictly pointing fingers at any one community. But with your background — Cigna, Humana — where did it go wrong? Where did the health insurance industry start to lose their moral compass?
WENDELL: I think it really began around the time that I joined the big for-profit companies. I had, in my first job in health care, worked for a nonprofit hospital-based system in east Tennessee, in Knoxville. It was the Abbott's Health System of East Tennessee, which has been absorbed into a much larger hospital system down there. I was recruited to go to Humana, and I was a true believer in the concept of managed care. I felt that it was something that really should be introduced to more Americans, that it could be, conceptually anyway, a way to improve care. The term value-based care was not in circulation much, as I recall that time. I don't remember hearing that term, but I essentially believed in that, that that was a way to make sure that we could make sure that more people, more Americans, could get care, would have access to valuable care that was timely and affordable and of high quality. And what I learned during my two decades working for two big companies was that those companies being publicly traded were especially, well, in fact, slavishly devoted to Wall Street. They lived and died by the whims of investors and Wall Street financial analysts. My name was on Cigna's earnings reports for 10 years, so I had to know how the company and how other companies made money, where it came from, what they did with it, what their business practices were to make sure that they were every three months satisfying those investors and those financial analysts, which few people even know exist. But they had inordinate influence over our health care system. So to be more succinct, I think we really went off the rails when we saw more and more health insurance companies convert to for-profit status. The first Blue Cross plan to do that was Blue Cross of California. That was in the mid-1990s. Prior to that, when I was growing up, when most of us of my age were growing up, all of the Blue Cross plans were nonprofit. Most people were getting their insurance through a nonprofit plan. Then big life insurance companies — Cigna and Aetna, had been in the group life business and multiple lines of health insurance — they and a few other big insurance companies saw an opportunity to make money by trying to attract younger and healthier people into their health plans. And that worked for them for quite a long time, but it began to skew the marketplace. And we saw in the mid-90s, the first conversion of a Blue Cross plan, now Elevance, which used to be called Anthem prior to that Wellpoint, owns about 14 of the Blue Cross plans around the country. It's one of those for-profit plans. So that's, in my view, we really — that was a turning point for the system. And also these companies, I learned — to meet Wall Street's financial expectations, they make it harder and harder for people to get the care that they need. They might, in fact, they frequently do use the term value-based care. But that's another thing I want to notice, I want to point out. I've seen along the way that these big companies have taken terms and concepts and have twisted it in ways that bear little resemblance to what the original concept was. And so I would encourage people to be skeptical when they — when you hear a big insurance company using the term value-based care.
JOHN: Wendell, it’s value-based. It’s value for them, right?
WENDELL: Exactly. I saw that the whole industry was really based on seeking profit. That was job number one Or job number one really was making sure that they could convince shareholders that they were returning value to them.
LISA: Wendell, I think your background is fascinating. And let's continue on this thread for a little bit. I drank the Kool-Aid, kind of live and die in population health, thinking that health care can be delivered a little bit better than what we're doing today, a lot better than what we're doing today, and that value-based care and population health are maybe an option to begin to build the muscle memory to be able to take care of populations. I didn't see it as a silver bullet or like a shiny object. But the industry has embraced this idea of value-based care. And the insurers have embraced the idea of — value-based care is great for me because it's just another way for me to extract more profit and more margin for myself and not have to return it back to the employers who are actually funding this. So when you look at this circle and you look at where we are today with healthcare, the uprise — everybody's talking about how expensive healthcare is and how it's crushing business and growth and development. What do you think are the one or two things that our political leaders could do to start to tackle this?
WENDELL: Yeah, they're beginning to. I'm seeing this at both the state level and in Washington. I spend a lot of time in Washington. I meet with a lot of congressional offices with members of Congress on both sides of the political aisle. Over the past year I bet you I met with 50 congressional offices, if not more, and more than half of those were Republican offices, and I'm finding that for the first time in, I think, ever, there is bipartisan interest in addressing many of the problems that we're seeing in our health care system. And the focus of a lot of their anger, their frustration, and their attention broadly is the insurance industry. And there are a number of bills. One that was introduced just a few weeks ago by two unlikely partners, Josh Hawley of Missouri and Elizabeth Warren of Massachusetts, introduced legislation that would essentially make it illegal for companies like the ones I work for to have the kind of structure that they have, the vertical integration that now is how they are, which was entirely different from what it was when I was in the industry. But as you know, these companies have gotten increasingly into healthcare delivery, into the pharmacy space, to the point that they're making a lot more money these days in that part of their business than they are from health insurance. So we're seeing a lot of interest in legislation that would make these companies divest some of their holdings. But there's a lot of also attention on more specific bills that would require more transparency, would really address the abuses of their pharmacy benefit managers. As you all know, the three big insurance companies or their parents control more than 80 percent of the pharmacy benefit market in this country. That's Cigna, which owns Express Scripts, CVS, which owns Caremark and Aetna, and United, which has Optum Rx. So a lot of members of Congress are — several at least, several are doctors and pharmacists, and they're beginning to see this. They're hearing it from their constituents. They had seen it firsthand in their physician practices or when they were working as pharmacists. So I think we're seeing a lot more attention. We're seeing that there's an awareness of how these companies have really ripped off taxpayers. There's a lot of scrutiny of the Medicare Advantage program, which has been a big cash cow. So I guess my point is that lawmakers are looking at pieces that they think is possible to address where there is some bipartisan interest. It's really hard, certainly, to get any piece of legislation passed because these companies have inordinate power and influence. When I was in the industry, when I was at Cigna, my team handed out campaign contributions. So I know how that works and how that makes it so difficult for important legislation to move forward. That said, I think it's possible now. When the debate was going on that led to the Affordable Care Act, Republicans and Democrats didn't agree on much of anything. And there were no Republicans who voted for the ACA. Again, I'm seeing a very different landscape now. They have different ideas about some of the fixes that they would implement or try to move forward. But there's a lot of agreement and a lot of focus, as I said, on how these giant corporations — I follow seven companies that are New York Stock Exchange companies. I look at their earnings reports every three months. It's just astonishing how much money they take in, how they make their profits, what their business practices are really like. So that's getting a lot more scrutiny than it ever has.
LISA: Yeah, we're seeing in Connecticut, there's a little more scrutiny in that direction. And when you look at the level of profit that the insurers are making, it's kind of hard to say we don't have enough money in health care to fix all the problems and give everybody insurance, right? But we're willing to strip away the insurance for everybody so that we can continue the profits. And we have to somehow figure that out because I think we're heading slowly towards a pretty big crisis in terms of our ability to deliver health care because the provider system is crumbling around us. So thank you for that.
WENDELL: I think the provider system is crumbling and you're witnessing or experiencing almost a demise of physician practices that are independent. It's increasingly difficult for providers to stay independent. And we've seen so many that have been acquired by hospital systems and more recently by insurance companies or at least their parents and private equity. UnitedHealth is the biggest employer of doctors in the country. And there's been research that's shown that they pay their own providers significantly more than they pay providers that are independent. And that is squeezing the independent providers. Something has to be done or we're going to see the complete disappearance of health care providers that are independent of any of these entities.
KIM: I feel duty bound to now say as the public health person here — and with worse outcomes. The outcomes on the independent side, anytime we have measured at a population level, the outcomes of independents versus big healthcare, the outcomes are better on the independent side.
WENDELL: Yeah.
KIM: And so to what Lisa just asked, and I'm so grateful for this conversation, Wendell, I'm really curious about — let's flip that same action question, but to patients and to clinician out in the field, what can they do this month is really my question to start pushing their shoulder against reform in the right direction. What I'm seeing is doctors who were never considering direct payments now saying, I think that's how I'm going to be able to maintain low income access in this new world. Right? I'm really curious. You've seen how good we are as an industry — as an industry as a whole and the insurance industry — at slapping new labels on things. And so I guess my wider question from the actions is really what are the tells? How can you tell what are the questions either as an employer, as a patient, as a clinician to know, are you participating in something that is truly different, right? Something truly putting their shoulder against reform, or are you participating in just the latest camouflage, right? Of, like, we slapped another value-based care label on it or the new flavor of the week. I'd love your thoughts.
WENDELL: Yeah. And let's talk about the term value. And you're exactly right. And as we said earlier, it's a term that has been co-opted, I think, by big insurance companies, I think employers, I think clinicians, everyone needs to be a bit more educated about what we're really talking about here and how it has been co-opted and be skeptical of what the big insurance companies are selling. I've often said that these companies have been experts — and I was a part of it — of getting people to believe things that just simply is not true and to believe that they've hit upon the latest silver bullet to fix everything. And they've persuaded employers all these years. So I think employers need to wake up and spend more time focused on what truly is value-based care, what is value, how they are being taken advantage of, in many cases really ripped off and stolen from because of the complexity of the contracts and the arrangements that they have with big carriers. Clinicians need to certainly look at the way they do business and do what they can to consider direct primary care if they're in primary care. The concern that I have is that we've got to make sure that we're not creating a system in which only the “haves” have access to the best care. We've got to make sure that all of us have access to good quality care. We are in company with a lot of rich people, a lot of people with means. So I think we'll always have to understand that and what that looks like as we are moving to a better healthcare system. But I believe that it is possible for all of us to have access — all of everyone in a population, in the community to have access to good care. And I hope clinicians and employers can understand that. As you know, there is a lot of folks — I'm thinking of Dave Chase here with Rosetta, who talks a lot about community-based care and how we can get that to be more prevalent in this country and move away from the big giant corporations that provide essentially the pretense of coverage for so many of us.
KIM: No, I think that's right. Americans really dislike being played. Having been an American my whole life, we do not like getting our pockets picked. And that feeling as a patient, that feeling as a doctor is universal. And that's part of where I couldn't agree with you more on — we have enough money in the system for everyone to have great care. That's not the right limiting factor. It's something else. It's our choices.
WENDELL: It is. Absolutely agree.
DONOVAN: Wendell, thank you for your insights. Since 2018, the focus of my work has largely been on identifying and eradicating commercial friction throughout supply chains. And when I was doing research for my book a couple of years ago, one of the things that really shocked me was that only 90 years ago, hospitals were actually putting up the seed money to create health insurers and doing that to stabilize their revenues and increase distribution of their services. Can you speak to the relationship between hospitals and big insurers based on your experience?
WENDELL: You're exactly right. Our system of health insurance had its origin, I think, exactly what you're talking about. It started really at Baylor Hospital in Texas. One of the administrators came up with the idea of a system in which, starting with teachers in the area in Dallas, would have access to hospital care, paying a modest amount on a monthly basis. It was really community-based care, and it was not only community-based, but everybody paid the same thing. There was no bias against people who might have more chronic conditions, and that was working pretty well. That became the beginnings of the Blue Cross system and grew to have similar systems around the country. They were not hospital-based as time went on, but the origins were in the hospital business. Blue Shield came along not long after that to be a means of providing coverage for people outside of the hospital setting for access to physician care. So that was the beginning of the Blue Cross Blue Shield organization. And for many, many years — and again, it was up until really the 1990s, all of those plans operated on a nonprofit basis. I'm not saying that it's impossible for there to be for-profit companies that can offer good quality care. But I haven't seen any evidence of anyone who's really pulled that off. So also around that same time, you had Kaiser Permanente on the West Coast providing care to their workers. That was kind of the beginning of employer-based coverage. So that was kind of the origins of how we began to provide health insurance to people in this country. And it seemed to be a means of controlling costs to a certain extent. That certainly is the problem. And one of the reasons why I think we saw a change. But I will speak to this a bit more. The CEO of Blue Cross of California in the 1990s said that his company was on the verge of bankruptcy. And partly it was because of big for-profit companies coming into the market, siphoning off the younger and healthier people in a given community and creating adverse selection for that Blue Cross plan. So that was a dynamic that was happening, and that led to more and more Blue Cross plans looking at a conversion. And we've seen that continue. There are still, as you know, many Blue Cross plans that continue to operate as not-for-profits. But the vast majority of people in this country now get their coverage through some entity that is a Wall Street-run company.
DONOVAN: Yeah, thank you for that, Wendell. So I want to focus specifically on the employer-sponsored market for a second. covers 170 million Americans. From your perspective for the insurance companies, is their customer, the hospitals, do they serve as distribution for wholesale distribution of hospital services and drug makers? Is that their role? Who's their customer? I think this is really the problem we have in so many of these conversations. Who is the customer? It's hard to know.
WENDELL: You're exactly right. To begin to answer that question or respond to it, I would say, as you all probably would agree, there are two basic ways to control costs. One is to improve or manage the utilization of health care goods and services. Another is to have some influence on the unit cost of goods and services. And insurance companies have kind of thrown in the towel on that latter. And in fact, they, as it's structured now, can actually benefit as health care costs go up. As the cost of a stay in the hospital goes up or a drug goes up, they, because they're sort of seen as the only game in town, they just hit their customers with higher premiums. I know from my days in the industry that our numbers guys would look to see what medical trend was and that would inform the company as to how to set rates for the next year. And it was almost an acquiescence that these companies were not capable and really didn't have much interest in controlling the unit costs of goods and services. I think that was even exacerbated or made even worse by something that was well-intended when the Affordable Care Act was passed was addressing the medical loss ratio because these companies now have to presumably spend 80 to 85 percent of their premiums on paying claims or for their enrollees health care. I think that's given them even less incentive to control medical inflation. To satisfy Wall Street, their attention has been focused on really penalizing patients and physicians. And we have seen that show up in high deductible plans, which we referenced earlier and was one of the reasons I left the industry. People are increasingly functionally uninsured in this country, even though they have a wallet, a card in their wallet that says they might have Cigna insurance or Aetna or whatever it might be. They all too often can't use it because they can't afford to pay their deductibles or their co-insurance or whatever it might be. They walk away from the pharmacy counter without their medications. Inadequate networks and the way the networks are structured to the benefit of insurance companies, not to patients. And the excessive use of prior authorization, or I would say the inappropriate use of prior authorization, they've erected all these barriers, as I call them. So that has been their emphasis. And I believe that employers are beginning to understand this and are looking for options other than what we often call BUCAH plans and see that there are other ways to give Americans access to high quality care.
DONOVAN: Yeah. So given these dynamics, do you think that it makes sense for an employer to outsource and delegate the management of their health care supply chain to legacy insurers?
WENDELL: I absolutely do not. I think that they absolutely need to take a good look at that and realize it is possible now for them to have more visibility into the big companies that they work with, the legacy carriers, if you will. And they have more information to understand this just makes no sense for us. And clearly, they can just look at what has been happening over the past few years as their costs have gone up. The average cost of a family policy in this country through an employer is around $27,000. And that doesn't include some of the out-of-pocket costs that people have to pay. So it's a burden to both employers and to their workers. And we've said this, I've even said it over time, this is not sustainable. And I think that employers are beginning to now realize, okay, it truly is not sustainable. A couple of years ago, the Purchasers Business Group on Health on the west coast did a survey of the country's top CEOs, and more than about 90 percent of them said the current system is not sustainable for them. So I think there is, at long last, an understanding on the part of employers that they have to do this in a different way and look beyond the legacy carriers in this country.
JOHN: Besides their legal fiduciary responsibility, you know, in the Consolidation Appropriation Act.
WENDELL: Exactly.
JOHN: I think I've often said there's a lot of misnomers in healthcare. For example, guys like me, we're in health systems. I used to tell people, I don't really want a health system. I do sick care. I don't do health care, right? That's what I do when you run a hospital, right? And I think the other big misnomer is we call insurance companies the payers.
WENDELL: Yes.
JOHN: And I think what's happened now, and I think the tipping point is two things. I think the idea of a high deductible plan is now all of a sudden consumers, really for the first time — because it's kind of new, right? Let's say 15 years or so. All of a sudden, they're paying a lot of money out of their pocket when they go to the doctor or to the pharmacy, where they used to just, you know, say, oh, I had to pay $5 or $10 copay. And mostly, I'm finding, when I talk to most employees, they actually don't think of also the premiums they're paying, right? Because it's just a deduction from their paycheck. They don't really see it. So all of a sudden, when they start doing the math, they go, wait a minute, I'm paying a few hundred bucks every paycheck for insurance and I'm paying a $5,000 or $8,000 deductible. Who the heck the payer is? And on the flip side, the employers, I think, are now realizing, hold it, we're the payers. So BUCAH people aren't the payers. It's the employers, employees, taxpayers from Medicaid, taxpayers from Medicare. And I think that's such a big myth. Would you agree with that statement?
WENDELL: Oh, I agree 100 percent. In fact, I have contributors to my newsletter who often will use the term payers, and I always strike that. It's hard to find what the right term is. I get that. They're not really insurers either. But I will strike payers because all too often they absolutely are not. They are using employers' and employees' money, as you know, and they're acting as third-party administrators. When I was at Cigna, more than 80 percent, and I'm sure it's probably still true, and it's true of many of the big companies, most of the people enrolled in their health plans, they call their health plans, are through their TPA business. But they are not payers. And I believe that even employees are beginning to understand that the money that they're having to — their share, their portion of the premium is going up and up and up every year.
JOHN: Right, right.
WENDELL: And it's been incremental. So people haven't paid a ton of attention to it or even understand that that's money that possibly could have been used to give them a pay raise instead of going to a big carrier.
JOHN: Right, right. And I think that's what the employers are finally realizing is, wait a minute, I'd rather give a raise to my employee or expand my company. Why the hell am I — And I think to Kim's earlier point, it's not like people are getting better care. That's the irony. They're paying more and actually getting poorer quality.
STEVE: Thanks so much, Wendell. Well, we have this tradition of asking this question, and I'm really looking forward to hearing your answer. Because, yeah, you've spent the better part of two decades shedding light on an industry that's been largely opaque. But like some of your earlier comments and the comments by Dave Chase, there are a bunch of bright spots and they are coalescing and there is movement. And you can see a little tick up in the MLR as being just, despite all the games, the MLR is ticking up, which doesn't bode well for the insurance companies. Oh, we shouldn't call them that, sorry. But I want you to put your blue sky hat on with all that you see over the last three or four decades of your life. If the stars align over the next two to three years, what is it going to look like? Are we going to go back to the BUCAHs being nonprofit? Are we going to have a regime change or regime alteration? What do you see the next version of this story playing out?
WENDELL: You know, I think that it's going to be hard probably to turn the clock back to just have non-profit health insurers. And again, I agree. Should we even use the word insurers? There's not been a term created that is really appropriate for what these big corporations are. But I think it's going to be imperative to really address the structure of these companies. Because if we don't, the big for-profits are going to own just about everything. That has to be curtailed in my view. And I think it probably will be. There's enough attention focused on that. We can learn from what is going on in the marketplace and really understand what the value of value-based care is and what it truly is. I think that's going to be a big part of what we do. And we can look even to systems abroad for how they're structured. Other countries have competing health insurance companies. Now, admittedly, most of them insist that they're or require that insurance companies that operate are on a nonprofit basis. That may not be necessary, but I think that we can have a structure that gives people different options and more options, possibly. I know that a lot of folks increasingly, or at least still, advocate for a single-payer health care system. I have even said myself that I think that would be better than the system that we have now for a lot of Americans, but I don't see that necessarily as being the path forward in this country. I think that we do value choice, and I think there is value in competition. But it has to be, I would say, a term that we have used, that I've used, and I think it's valid here, is market failure. We've seen that our current system of health insurance has failed us, and we've got to have a new model. And I think that we can find it.
STEVE: What market? That's the question.
WENDELL: Right, exactly. That's the ultimate question.
STEVE: Thank you so much.
WENDELL: No one has the answer to that. We're going to see how that comes together. But I do believe that the power and influence of the big insurance conglomerates has to be curtailed and these companies broken up in some form or fashion.
JOHN: We couldn't agree more, especially to your earlier point of how they have now. I don't want to pick on anybody, but not only the employees, they have the doctors on their payroll and they manage the PBM market 80 to 90 percent management. Even the pharmacy distribution model is owned by the same. So you have, it's a real oligarchy in healthcare. And I think breaking up the monopoly to your point is probably where some of this is going to start now. You know, we've been saying unsustainable, by the way — first time I heard that was about 20 years ago.
WENDELL: Exactly.
JOHN: And I keep thinking, maybe it isn’t sustainable, but we keep doing it. But I do totally believe, really believe today, it really is unsustainable. So I think people, a lot of people from different angles are getting it, particularly the employers. I think ultimately, and I think to Donovan's point, I think the employers are the ones, besides their fiduciary responsibility, they're just sick and tired of paying these double-digit increases year over year over year, not being able to pass on some of their profits to their own employees or to their businesses. Wendell, thank you so much for joining Moving to Value on Scripted today. It's really been a pleasure. We certainly wish you well, and let's keep up the fight.
WENDELL: Thank you, John. Thank you all.
JOHN: To learn more about MTVA and how to join our community, visit our website, movingtovalue.org. If you enjoyed this conversation, please follow us and leave a review on Spotify or Apple Podcasts. Thanks again for listening and for being part of this important movement.
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