Matt dives into a specific healthcare topic to help those in the industry, and those outside of it, better understand the market drivers causing today’s healthcare challenges.

That's not a statistic. That's a system signaling collapse.

The West Health-Gallup survey published in November 2025 documents what I've witnessed from both sides of the healthcare divide—as a pharma executive who helped set the prices, and as a patient who spent 18 years in chronic pain despite having what everyone called "excellent" insurance.

The data reveals an unprecedented crisis. But the real story lives in what the data doesn't measure.

My family pays nearly $30,000 annually in premiums. Before anyone sees a doctor, we face an $8,000 deductible. Then come the copays. Then the coinsurance.

Commercial insurance has become a glorified coupon book.

The survey shows family premiums hit $26,993 this year, with workers contributing $6,850 from their paychecks. Most employees don't realize they're paying this hidden tax because they only look at their take-home amount.

Healthcare costs are rising 6% annually while general inflation sits at 2.7% and wage growth at 4%. The math doesn't work. It can't work. It was never designed to work for patients.

The survey ranked states by healthcare performance. Even in the top-performing states, 15% of residents can't afford their medications. In the lowest-ranked states, that number hits 29%.

Here's what nobody's saying: insurance coverage and patient outcomes are fundamentally disconnected.

I had excellent insurance through Eli Lilly. I still spent 18 years in chronic pain before finding the right surgeon. The system kept throwing Band-Aids—opiates, anti-anxiety drugs, anti-depressants. That's not healthcare. That's sick care.

The current model limits physicians to 5-7 minutes per patient. They see 40+ patients daily just to keep revenue flowing. There's no time to understand complicated issues or surgical histories. Physician apathy isn't a character flaw. It's a business model that no physician wants to practice, but has no time or pull to do otherwise!

Here's the mechanism nobody talks about: baseline budgeting uses the previous year's budget as the starting point for next year, without evaluating fraud, waste, or abuse.

Patients are never part of these internal budgeting processes. Nobody asks how families fared paying for healthcare last year. The system expects you to shoulder the load and keep paying higher premiums.

Pricing gets set without patient insight. Financial constraints don't factor into the equation. The survey shows 35% of Americans—91 million people—report they couldn't access quality healthcare if they needed it today. That's financial toxicity at scale.

Three PBMs now control 80% of all prescriptions in America. They're vertically integrated with major insurers—CVS/Caremark with Aetna, Express Scripts with Cigna, OptumRx with UnitedHealthcare.

These companies own the PBM, the specialty pharmacy, the retail pharmacy, the surgery centers, and even provider practices. They make tens of billions in quarterly profit while premiums climb year after year.

We have too little competition. The insurance companies have amassed so much power and lobbying money that they get everything they want. That's not in the best interest of patients or clinicians.

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Congress is debating whether to extend ACA subsidies that expire December 31. If they lapse, premiums will double for more than 20 million Americans. The average subsidy recipient would see annual premium payments jump 114%—from $888 to $1,904.

But here's the question nobody's asking: Why are premiums so high in the first place, and why have they continued to rise when the risk pool expanded post-ACA implementation?

The ACA was sold as competition and cost reduction. Instead, it guaranteed customers to insurance companies, subsidized by taxpayers. Since its founding, costs have only increased to insane levels. Nothing has gotten cheaper, even though by law everyone must now have health insurance.

Based on pure economics and math alone, that should not be. This clearly points to crony capitalism, where winners are allowed to win as much as they want, at the expense of everyone else.

The survey shows 55% of Americans cite long wait times as preventing care. Another 27% mention work schedule conflicts. One-third skipped recommended medical procedures due to cost.

When financial barriers become reality for millions simultaneously, people skip appointments or delay care. This leads to worsening symptoms, disease progression, and medication non-compliance.

All leading to worse health outcomes, decreased presenteeism at work, and decreased productivity.

This isn't a healthcare crisis. It's an economic crisis. Healthcare in its current form is just economics.

Policymakers focus on extending subsidies or implementing Medicaid work requirements. They're addressing insurance coverage while missing the fundamental problem: just because you have insurance doesn't mean you can afford to use it.

The one intervention that would actually address this crisis? Blow up the vertically integrated insurance marketplace.

If patients started treating every healthcare interaction as an economic transaction and voted with their wallets, the PBMs would not be tolerated. Patients would see the cash price of medications versus the insurance-negotiated price and realize commercial insurance provides no benefit unless you face a catastrophic illness or injury.

As citizens, we all have the power to vote. Educate yourself. Understand the risks and benefits of any position you take—whether that's Medicare for All or a better capitalist system than we have now.

But as citizens in a capitalist economy, you have another right: the right to participate or not with different providers, pharmacies, and systems.

If you're not getting value for your money, fire that provider and find one willing to ensure the care is worth your dollars.

The system is about to implode as patients begin to understand that the ACA was a handout to insurance companies. Since the ACA's founding, we've only seen costs increase while competition disappeared.

47% of Americans fear they can't afford healthcare in 2026. That fear is justified. The question is what we do with it.

I am done asking patients to wait for a system that keeps falling short. I am building what comes next.

The Advocacy Influence Diagnostic will help advocacy leaders and teams assess their perceived value and growth opportunities.

We The Patients, will turn lived experience into an organized patient voice.

The EMPWRD Patient online community and training platform will equip patients and caregivers with practical knowledge, support, and advocacy tools. (Coming Soon)

The EMPWRD patient record app will help people organize their story, track their care, and show up prepared when decisions matter most. (Coming Soon)

This is how we move from frustration to action. Join the early access list. Help shape these tools. Bring your experience. Bring your voice. Help build a healthcare system that finally works with patients.

Patient impact: better information, stronger self-advocacy, more coordinated care, and a clearer path to better outcomes.