What is the real cost of your health plan? In this episode of The Healthcare Heist Podcast, Lou Bernardi shifts the focus from how the system works to what it’s actually doing to your employees, your culture, and your bottom line.
This isn’t just about rising premiums. It’s about unnecessary procedures, preventable errors, and a system that too often rewards volume over value. It’s about employees delaying care, taking on medical debt, and making impossible decisions at the kitchen table—choices that follow them into the workplace every single day. Lou breaks down how these issues show up inside your organization as absenteeism, presenteeism, declining morale, and rising costs—and why doing nothing is no longer a neutral decision. You’ll also learn how the system’s business model is designed to sustain these outcomes, and why waiting for external reform is not a strategy.
But this episode doesn’t stop at the problem. It introduces a powerful shift in perspective: The dollars being lost aren’t gone. They’re misallocated. And when employers begin to take control, those dollars can be reclaimed and reinvested, creating what Lou calls the Healthcare Dividend. Because the true cost of healthcare isn’t just what you spend…It’s what you’re forced to give up.
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Listen to the podcast here
How The Broken Healthcare System Hurts Your People And Your Profits
The Real Toll And Why Leaders Can’t Afford To Ignore It
Welcome to the show, where we pull back the curtain on one of the biggest, most misunderstood expenses in your business. I am your host, Louis Bernardi, founder of BritePath and a benefit optimization officer, certified healthcare fiduciary coach and health value advisor. If you’re a CEO, CFO or HR leader who knows something isn’t adding up with your health plan, you’re in the right place. In the last episode, I shared why this became personal for me.
The Real Cost Of Doing Nothing
Why I flipped from being part of the system, being part of the heist, a muscle to helping employers challenge it and why I wrote my book, Inside the Healthcare Heist. I’ve spent the last 7 to 8 years working on a book with the hopes that it will provide business decision makers with the information resources they need to make smart healthcare decisions.
I want to talk about something even more important than my background and why I flipped. The real cost of doing nothing because what most employers do is just try to get this insurance premiums down as much as they can. They negotiate insurance. You’re not buying insurance. You’re purchasing healthcare for your employees and financing that with insurance. What you know very little about is the cost and quality of the health care that you’re getting.
You don’t get itemized bills. It’s shroud in secrecy and that’s where your health plan breaks down. This is not theoretical. Before you can fix a problem, you have to see it clearly. You don’t need to know the thousands of ways health insurers and health systems manipulate the prices. You do need to understand that that’s what’s happening. You need to get a healthy amount of animality. Not enough to hurt someone. Enough to take action, to devote time and to understand the opportunity.
Before you can fix a problem, you have to see it clearly. You don’t need to understand every way insurers and health systems manipulate prices—you just need to know that they do. Share on XThe truth is the waist is so enormous that the dividend that you can get back from this can be life altering for your employees, yourself, and your business. Most leaders don’t see the full picture. It’s not just about rising premiums. It’s about broken care, distracted employees, absenteeism, presenteeism and lost growth. Until you see the toll clearly, the machine, the animal behind the health care heist, the motives, the misaligned incentives behind the healthcare heist. You won’t be able to do anything about it.
Let’s talk about broken care. If the healthcare system were judged like any other industry, it would fail basic performance standards. Truthfully, the US healthcare system does just that. It ranks dead last in just about every category of health care quality and number one in price. Not price in a favorable way. Exorbitant cost. Every day, there are preventable errors and unnecessary procedures. Tens of thousands of medical errors. Treatments don’t improve outcomes but do increase billing. It’s not rare. It’s the result of a system that rewards volume. Not valium.
More care doesn’t mean better care. It means more claims, more cost, higher premiums and often more harm. With human impact, let’s talk about your Workforce. Broken care shows up in many ways. Employees with unmanaged conditions and unable to get care for their conditions because of the exorbitant out-of-pocket cost. They miss work days for themselves or their loved ones. People showing up but not fully present. They’re distracted because a loved one at home is ill or they’re getting bills that they can’t pay. They’re forced to choose between the electricity and the medical bill.
Here’s the part that matters. That stress that they’re experiencing doesn’t stay home. It walks through your doors every single day. The kitchen table reality. Healthcare doesn’t just hit your balance sheet. It hits the kitchen table. Employees are making possible decisions, “Do I pay this bill or the mortgage? Do I fill this prescription or buy groceries?” These aren’t bad decisions. They are survival decisions forced by a system designed to extract the maximum dollar at the worst possible moment. You are financing it. Inevitably, health insurers and the healthcare decision or said ecosystems don’t design your health plan.
They don’t design your premiums. They don’t decide your out-of-pocket cost. They don’t determine the resources you give your employees to find high value care. You do. That’s the power you have as the American Healthcare consumer. Health insurers and healthcare systems have had to leverage for the last 30 years. They’ve held on to all the data. They’ve kept you silent. They’ve kept you guessing, but they’re concerned because they know regulations, information and technology are out there. When AI is used to its full extent by the American Healthcare consumer, it can change markets.
It can determine where you go to take your care and they are looking very closely. If you don’t act, they won’t change. Remember this is the highest at its most personal. Health is compromised. Dignity is lost. Financial security disappears. Why does it keep happening? Why does it continue? It’s because it’s profitable. Everyone but the employer and their employees benefits when your cost increase. Health Systems, health insurers, pharmacy benefit managers and benefit brokers all get paid more when your costs go up.
The System Is Designed To Steer Care Towards Higher Cost Services
The system is designed to steer care towards higher cost services. That’s why hospitals systems merged with other hospital systems to gain leverage so that they can negotiate with insurance carriers. That’s why they ultimately decided, “Let’s move downstream. Let’s take over the outpatient centers, the ambulatory, the urgent Cares, the labs, the radiologists, and the specialists. Let’s put our logo on the door of your primary care doctors who you trust.”
Use those doctors and keep them in the dark just enough so that when they tell those doctors where they should send their patients, they follow. They’re marching orders and they send you to where the care is the most costly, where it’s the most profitable for them. Prescription drug prices in this country are manipulated to rebates and spread pricing. They hide the truth. The true cost behind contracts and discounts gag orders. You’re not allowed to know. Now, this isn’t true anymore. You’re entitled to the prices. Your employees are required to have access to the prices.
It’s your obligation as an employer to provide that to them. You probably are unknowingly because if you’re aligned with a large national insurance carrier, inside your member portal or resources that your employees probably aren’t even aware of. Not necessarily meant to help them make smart decisions but meant to help you comply on knowingly so that another compliance box is checked. Are you using it to the full extent that it was meant for?
Here’s what most employers don’t realize. The same organizations often control your insurance, the providers and the pharmacy supply chain. They’re paying your claims to themselves. They’re dictating the prices and they’re getting the rebates because they hold the coupons behind the scenes while your costs go up. They’re negotiating with themselves and often paying themselves, their sister companies 25% to 61% more based on research than they pay the other doctors. You’re funding that outcome.
There’s a hidden tax on your business. For your business, this becomes a silent drain. Every dollar spent on inflated claims is a dollar you can’t invest in wages, technology, growth, and retention and valuation shrink because you’re overpaying for health insurance. This is the hidden tax of the health care heist. Over time, it erodes trust. Benefits stop feeling like protection and start feeling like a burden. When was the last time you had a candidate that you wanted to hire and you felt proud of the health plan you slid across the table to them?
It’s a silent drain: every dollar spent on inflated claims is a dollar not invested in wages, technology, growth, or retention. Over time, it erodes both performance and valuation. This is the hidden tax of healthcare. Share on XWhen was the last time you highlighted your health plan instead of hiding it from them? Hoping that they didn’t need it that much and they walked away after they saw it. Why doesn’t waiting work? If this isn’t so obvious, why hasn’t it been fixed? It is obvious and it is being fixed but not quickly. Not necessarily for you. When you watch the news and you hear about the most favorite nation pricing for prescriptions, you get excited. Until you realize that does not apply to your commercial health insurance plan. That’s the government subsidized plan. That’s Medicare or Medicaid VA. They’re getting the best prices. While you, the commercial insurance member and plans sponsor overpay for everything.
The system is protected by lobby money, power, influence, and votes. Waiting for someone else to fix it is not a strategy. It’s a surrender. The cost of doing nothing isn’t neutral. It’s not the easy way. It’s a decision. A decision to let costs rise. A decision to let employees struggle and let capital leave your business. That’s what this book is all about. It’s helping you understand the problem a little clearer than you do now so that you can elevate your IQ and probably set your expectations because that is the problem, ladies and gentlemen.
The American healthcare consumer has been groomed for so long that the expectations are minimal. The employers that are asking for more are getting more. Again, check out HealthRosetta.org website. You’ll see the Rosie Award winners like our client Oradell Animal Hospital who saved $1.2 million that represented about 25 of their entire health claims spend the prior year. Did they didn’t understand every different thing that we were doing? They did understand that it was working and then it was an improvement for their employees.
We didn’t water down the benefits. We kept them status quo. We built a plan with more bells and whistles behind the scenes and more help and resources for their employees. Especially the most vulnerable employees. That’s what you need to do. The truth is, very low percentage of employees use your plan. The ones that do, really use your plan. They’re probably 5% to 10% that account for 50% or more of your total health care spend claims spent.
The Opportunity: The Healthcare Dividend
Doing nothing isn’t neutral. It’s a decision. It’s a decision to let everything increase. Every renewal without real chains makes the problem worse. The opportunity is what we want to focus on. Here’s the part most leaders haven’t been shown. The money isn’t gone. It’s just misallocated. Employers who take control of their health care regularly reduce cost by 20% to 25%. That 20% to 25% that used to be electronically transferred to your insurance carrier stays in your bank account without cutting benefits.
When that happens, something powerful emerges. It’s called the healthcare dividend. I call it the dividend because that’s exactly what it is. It’s a return of your current expense, return on your investment into a high performance plan. The savings that comes from fixing the system can be reinvested into anything you’d like it to. Better wages and lower employee costs contribute to higher attraction of top talent.
The savings from fixing the system can be reinvested anywhere you choose—better wages, lower employee costs, stronger talent attraction, improved benefits, and better tools for HR. Share on XStronger benefits and better tools for HR. HR person, what if that technology, that new AI tool that you need that can make your life easier could be funded by the waste in your healthcare plan? CEO, CFOs, you’re working on your evaluation. You’re trying to borrow money, but your finances just don’t add up. Guess what? You’re sitting on a pot of gold that can be reinvested right back into your company. Increase your EBITDA, your attractiveness for investors or investments. Healthcare goes from being a liability into a strategic advantage.
It’s not only an HR issue. It’s a leadership issue. When Healthcare is left on autopilot, the machine wins. It depends on silence, inertia and acceptance. We’ve heard every excuse under the sun. That’s disruptive to change carriers. It’s not. Not when it’s done properly. Our employees won’t understand that’s a cop out. Your employees are much more intelligent than you give them credit for. They’re not children. That’s the way we think about our children.
When push comes to shove, if you put positive incentives and you give your employees the resources they need to make smart healthcare decisions. We’re just talking about using the innate consumer that’s already in them and applying that to healthcare. You wouldn’t tolerate this level of dysfunction anywhere else in your business. Healthcare shouldn’t be an exception. Every unnecessary procedure, every preventable, every dollar of medical debt is the system working exactly as it’s designed.
The only question is, will you continue underwriting it or will you step in? Will you devote a little more time and change the outcome? That’s enough for me for this episode. Thanks for tuning in to the show. I hope you learned a thing or two. More importantly, I hope it helps you get the results you and your people deserve. Until next time. Don’t settle for a health plan that isn’t working as hard as it should for you and your team. You know how to contact me. Connect with me on LinkedIn. I look forward to our next episode. Thank you.
Important Links
- Louis Bernardi on LinkedIn
- Louis Bernardi on Substack
- BritePath
- Health Rosetta
- Oradell Animal Hospital