Tell me, what's the answer?

All right, so 2023, we were given the right to self-pay, right? No Surprise Act was passed in 2020, right? In 2023, the right to self-pay effectively took effect.

What is the right to self-pay that nobody is using You go back to 2015-16, you went into a doctor's office and said, no, no, I just want to pay myself today.

They'd say, sir, I see you have Cigna.

It's in your record here.

Do you still have Cigna? Well, I do, but I'm not going to hit my deductible this year.

I'd like to self-pay.

So how should an employer think about this? If an employer is looking at insurance or their healthcare spend being 10 million a year or 20 million a year or a quarter of a billion a year, and they're used to doing things the same old way, how do you help?

You're good, Matt,

right? The first section of the book really goes through 75 years of history from World War II as to how our healthcare system got to where it is.

And I've written it, or so I'm told, in a way that is not a boring history.

It's a very engaging, gripping kind of you know holy cow can this really be true this makes so much sense now i understand why things are the way they are and with that foundation then once we understand why is the system as broken as it is why is it going to be impossible for government to fix it for us here is the blueprint for how american businesses can really drive change in the system and it's really about applying the same principles to health care that companies have been applying to their businesses for the last 50 years, right? Toyota production system, lean principles, and really recognizing that employers who foot the bill for healthcare and are under law, the insurer, right? It's not United Healthcare.

It's not Cigna.

It's not Aetna.

Self-insured employers, which is 80% of companies with more than 100 employees, are actually the insurer.

i do thank you uh david you know one of the i work with a lot of small businesses so we'll say revenue of 10 million or less and it's when i started almost 30 years ago a lot of the companies offered health care programs of some sort it is so rare to see that these days is that an area that you see improvement in coming up just so many businesses small businesses just find it insurmountable from a cost perspective

When does an employer become more than a buyer of benefits? When do they become responsible for the system they're sponsoring? Is it from day one of the business or is it later than that?

Yeah.

So, you know, in a very small business these days, it's common to not offer benefits to your employees at all.

Right.

And it's cheaper to do things that way.

There's lots of ways to evolve into a business of 5, 10, 15, 20 people where you don't have to worry about benefits because you know what? The only people who are going to come work for you are people who are either young and healthy and don't care.

People who have a spouse with a good job and they're on their benefits plan.

And that's a very different kind of broader leadership perspective also.