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95. Healthcare Price Disparity and Health Plan Landscape

95. Healthcare Price Disparity and Health Plan Landscape

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 We are covering two topics in this edition – healthcare price disparity between the U.S. and other developed countries as well as the current health plan landscape. About The Podcast: Millions of Americans feel confused and frustrated in their search for quality healthcare coverage. Between out-of-control costs, countless inefficiencies, a lack of affordable universal access, and little focus on wellness and prevention, the system is clearly in dire need of change. Hosted by healthcare policy and technology expert Marc S. Ryan, the Healthcare Labyrinth Podcast offers accessible, incisive deep dives on the most pressing issues and events in American healthcare. Marc seeks to help Americans become wiser consumers and navigate the healthcare maze with more confidence and certainty through The Healthcare Labyrinth website and his book of the same name. Marc is an unconventional Republican who believes that affordable universal access is a wise and prudent investment. He recommends common-sense solutions to reform American healthcare. Tune in every week as Marc examines the latest developments in the space, offering analysis, insights, and predictions on the changing state of healthcare in America. About The Episode: On this episode, Marc covers two topics – healthcare price disparity between the U.S. and other developed countries as well as the current health plan landscape. Key Takeaways: Part 1: Price Disparity The Peterson-KFF Health System tracker looked at price and utilization in the U.S. and 11 other developed nations. It finds that the U.S. has higher prices for many healthcare services and that we spend more than any other large, developed country on healthcare. However, utilization of many services is lower than in many comparable countries. The study says this has been the case for some time. Costs ultimately are driven by price and utilization. In this case, the study says price in America is the big culprit for higher costs than in other nations. The U.S. spends nearly twice as much on healthcare per person as the average of peer nations. Part 2: Health Plan Landscape There is an ongoing financial meltdown at health plans and the One Big Beautiful Bill will not help matters in terms of recovery. There are a number of different unsettling things on Medicare Advantage, including poor Star performance, risk adjustment revenue scrutiny, and prior authorization limits. Expect more benefit and other contraction in MA in 2026. Plans will need to pivot to real-time data analysis and engagement to reduce costs due to restrictions on prior authorization across all business lines. Plans will also look at agentic AI to help reduce administrative costs and enhance member and provider outreach. Ultimately, we need healthcare reform focusing on price reform, wellness and care management, and affordable access. Connect With Marc: Marc on LinkedIn Marc on Twitter THL Podcast Resources: THL’s Newsfeed THL’s Blog The Healthcare Labyrinth: A Guide to Navigating Health Plans and Fixing American Health Insurance
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