Your health insurance keeps getting more expensive, and one big reason isn’t new at all: Decades of healthcare consolidation have created near-monopolies with too much pricing power, @LisaMJarvis writes (via @opinion)

Your health plan costs the same as a Tesla Model Y. I sat down with Ali Diab, CEO and co-founder of Collective Health, to find out what Collective Health is doing to fix it. Ali started the company after his own hospital claim got denied, and has spent the decade since building what he calls the “Stripe” of healthcare benefits — for employers today, and potentially insurers and health systems tomorrow. This episode hits the affordability crisis head-on. Ali makes the case that health insurance itself is the real inflationary catalyst in American healthcare. Ali doesn't do the polite version. He calls the MLR a cost-plus contract, compares network "discounts" to markdowns off the Neiman Marcus price, and told me about the time he was charged $340 in coinsurance for a $125 knee brace on his own company's plan. We dig into why self-insurance and direct contracting are eating the fully-insured market alive, why small employers are legally boxed out of self-funding, and why he thinks healthcare pricing needs an SEC. Also: World Cup takes. Ali's a winger-turned-number-nine and I broke two leg bones playing this sport, so we earned the tangent. Listen on Apple: Listen on Spotify: TIMESTAMPS (04:31) A denied hospital claim, a Stanford doc spending more time fighting insurers than seeing patients, and the founding of Collective Health (08:34) Your family's premium buys a Tesla Model Y every year — and the MLR is the $600 Navy toilet seat problem in disguise (16:35) America is over-insured: stop running windshield wipers through car insurance (and birth control through health plans) (18:55) Network discounts are markdowns off the Neiman Marcus price — the PBM rebate illusion explained (20:19) From 25 lives to Walmart: the self-funding playbook carriers lobbied your state to keep away from you (27:24) The $340 knee brace story (retail price: $125 — and no, he couldn't bring his own) (37:35) Inside the 3.9% vs. 9% trend gap: how routing members in real time actually bends cost (52:44) Give healthcare an SEC: why Ali thinks price discrimination in care delivery is a solved problem we refuse to solve

The average US family health insurance premium, per KFF’s annual survey: 1999: $6,000 2002: $8,000 2005: $11,000 2008: $13,000 2011: $15,000 2014: $17,000 2017: $19,000 2020: $21,000 2023: $24,000 2026: $28,000 That’s up 387% since 1999, about 6% a year. Inflation over the same period: about 2.6% a year.

"To combat rising health care costs, people have said they are forgoing health insurance coverage, rationing their medications, cutting back on doctor visits and putting off health procedures," per WaPo