My Books

Healthcare costs are unsustainable.
Employers need to think differently.

For decades, the cost of employer health plans has climbed every single year, and almost no one in the industry can give a straight answer as to why. In The Lean Health Plan, I trace the rise to a long chain of decisions, each one defensible on its own, that together turned the company health plan into the most expensive and least controlled line item on the books.

From there, I get specific about the culprit. Most of what gets processed as a "claim" is routine, predictable care, not the rare, catastrophic events insurance was built for. It’s a checkup, a lab test, or a generic prescription, forced through an insurance machine that codes it, marks it up, and passes it between middlemen who each take a cut. I argue that the claim itself is the problem, and that employers who stop running routine care through the insurance machine can cut their healthcare costs by as much as half.

The last part of the book widens the lens. Left unchecked, healthcare costs won’t just strain company budgets, they threaten the broader economy, and Washington has shown no real ability to stop it. I make the case that employers, the ones actually paying the bills, are the only ones with the leverage to fix this, for their own companies and ultimately for everyone else.

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Why I wrote this book for employers

For twenty years, I advised some of the biggest names in healthcare, applying Lean to nearly every part of the industry except the one driving employer healthcare costs: the financial and administrative machinery sitting on top of patient care. I also spent years fighting for the rules that forced hospitals and insurers to disclose their prices. Transparency is necessary, but it’s not sufficient on its own, not as long as one of the traditional carriers runs the plan. The Lean Health Plan is a new approach: it applies Lean directly to the employer health plan for the first time, and gives employers a concrete way to act on the prices that transparency finally put in the open.

Thanks for reading, and I hope it gives you something to act on.

-David