The Price We Pay: What Broke American Health Care--and How to Fix It

by Marty Makary

That night, I learned things they don’t teach in health policy textbooks or graduate schools. I learned, in vivid detail, exactly how insurance brokers get kickbacks for selling health insurance and pharmacy benefit manager plans to employers, just as Contorno had explained to me. I realized that brokers are often the shepherds leading the sheep. They can convince an employer to buy an overpriced plan or a great value plan. They can convince an employer to switch insurance carriers, stick with their current carrier, go to the mat for a better price, or bypass health insurance and simply self-insure. Brokers have a lot of power. Employers grow to trust them. But what employers don’t know is how insurance companies use cash to control the brokers. At the Orlando conference, I heard story after story of companies calling brokers to dangle a big bonus in front of them if they kept an employer on the hook. I