Ben Handel

That's something that's not real.

$2,000 gone, but people don't know.

And the reason is that it's very hard to get certainty on this dimension.

Yes, exactly.

That's very common.

We talked about the sludge that insurers impose on patients, right?

We haven't talked yet about the relationship between insurers and doctors and insurers and providers.

In fact, insurers routinely make the case that they're the only thing holding us back from health care spending being 30 percent of GDP because they're the ones bargaining with doctors and trying to get lower prices.

What's the sludge there, though, between providers and health care firms?

So with what I was just talking about with the bargaining, I don't think that that's a sludge area.

But there is a whole important sludge area, which comes from the rationing restrictions insurers impose that doctors have to mediate and contend with.

So let me give you an example.

Say an insurer denies care for something and then the physician has to haggle with the insurer to get any money from this payment because the provider is often not going to make the patient pay.

Essentially, what the insurer does is they impose all of these administrative burdens on the doctors, paperwork, back and forth with the insurer.

And this paperwork is all designed to discourage care, or as the insurer would say, encourage appropriate care.

One of the things that we've seen in the past five to 10 years is physicians becoming completely fed up dealing with insurers.

There's a recent article in the American Journal of Managed Care that the survey is like 500 physicians and it basically shows 94% of physicians say these administrative issues are a huge burden.

64% say they've experienced burnout in part because of these administrative frictions and that they might want to leave becoming a doctor.

And what this has led to is the last five to 10 years, insurers and venture capitalists have just been hoovering up all the smaller doctor practices.

And so now it's almost...