A House Divided
The "Talksalot" People vs. The "Doesalot" People.
Healthcare shouldn't be political. The politicians on both sides have spent decades pointing fingers, passing thousands of pages of regulations, and doing little to enforce the price transparency rules already on the books. The system is divided into two groups: The Talksalot people and the Doesalot people.
The Talksalot people write policy papers, host benefits conferences, and bill by the hour.
The Doesalot people build governance, read line-item claim files, and protect Plan assets.
I don't run in political or legacy broker circles. I don't talk. I do. See the actual receipts of what a "Doesalot" fiduciary review looks like below.
The Discount Illusion
A 68% PPO discount sounds impressive until you realize the starting price was 6,100% of Medicare. A percentage discount doesn't tell you whether the underlying price was reasonable.
The pie chart comes from the Nevada PEBP website. They are bleeding money.
Real Chargemaster Data
The Receipts: Real Chargemaster Data
Lumbar Spine MRI · CPT 72148 · $1,800 Deductible / 30% Coinsurance / $5,000 Max OOP
MRI + office visit + facility fee. No models. No averages. Actual hospital chargemasters vs. independent provider pricing.
Scenario
Georgia
Hospital Route
Insurance
Independent
Cost Sharing Waived
Scenario
Pennsylvania
Hospital Route
Insurance
Independent
Cost Sharing Waived
The Insurance "Network Discount" Trap: Waiving cost sharing at independent providers reduces total plan reimbursement. Employees pay nothing. The Plan pays less. This is how fiduciaries enforce reasonable reimbursement.