ONLY HEALTHCARE

In this episode of the Only Healthcare Podcast, Michael Navin and Randy Vogenberg welcome healthcare attorney, policy advocate, and author Chris Deacon for an in-depth conversation on how structural incentives, middlemen, and lack of transparency have reshaped the U.S. healthcare system. Drawing from her experience overseeing New Jersey’s state health benefits program and her book The Great American Healthcare Heist, Chris explains how employers and public sector plans are increasingly squeezed by rising costs, opaque pharmacy benefit structures, hospital consolidation, and technology deployed to optimize revenue rather than reduce spend. The episode explores why understanding contracts, data, and incentives is critical and where real opportunities for reform may still exist. Key Topics Discussed • How healthcare incentives became misaligned across the system • Why transparency is essential to restoring affordability • The evolving role and impact of pharmacy benefit managers • FDA approval, drug marketing, and assumptions about efficacy • Vertical integration and the corporatization of medicine • Public sector healthcare insolvency and budget crowd-out • How AI is being used to optimize billing rather than reduce costs • Practical levers employers can use to regain control Episode Chapters with Time-Stamps 00:04 – Welcome and introduction to Chris Deacon 01:01 – Chris’s background in public service and healthcare oversight 03:12 – Why state healthcare plans mirror the commercial market 04:16 – The motivation behind The Great American Healthcare Heist 07:28 – Training gaps and healthcare literacy challenges 09:07 – Pharmacy benefits, PBMs, and middlemen dynamics 12:21 – FDA approval, drug marketing, and flawed assumptions 14:49 – Healthcare spending surpasses $5 trillion 16:04 – Public sector insolvency and budget crowd-out 18:54 – AI, revenue optimization, and unintended consequences 20:17 – Hospital consolidation and vertical integration 23:20 – Transparency, direct contracting, and paths forward 26:22 – Practical levers employers can pull today 29:19 – Early signs of market change 31:27 – Closing reflections and call to action Michael's LinkedIn Randy's LinkedIn Sponsored by: Peek: A game-changing prescription shopping solution that allows its members to view all their prescription cost options across cash discount programs and their insurance in one easy-to-use platform. Peek is currently being offered to organizations to help both employees and plan sponsors save money on their prescription spend. https://peekmeds.com/. Institute for Integrated Health (IIH): Health care benefits, insurance coverage regulations, and doing business in the healthcare industry can be complicated. At IIH, Dr. Randy Vogenberg and his team understand these unique challenges and provides strategic guidance customized to every client. To help overcome your unique challenges, IIH delivers education, planning and advisory on market trends, and U.S. health care market intelligence. The firm’s decades of proven success are due to strategic collaboration with associates from the business, clinical, and scientific communities. https://iih-online.com/.