How Health Insurance Was Broken Over The Last 40 Years | with John Rutledge

"The biggest shift was the consolidation that happened with the insurance carriers themselves. From 25 or more carriers to just four national carriers." - John Rutledge How did health insurance get so broken? My guest this week, 40-year industry veteran John Rutledge of Marsh McLennan Agency, joins the show to walk us through the last 40 years of decisions that led us to the consolidated, expensive, and frustrating market we have today. John explains how the market went from over 25 competing carriers to just four national players. We discuss how the rise of carrier-owned PPOs squeezed out competition, and how the ACA later standardized coverage, locking employers into the "Buca box" with painfully limited options. But this isn't just a history lesson. We also discuss the solution that has emerged from the ashes of the old system: the explosion of self-funding and alternative risk models like captives that empower employers to finally break free. Tune in for a masterclass on how health insurance was broken, and more importantly, how we can start to fix it. Chapters: (00:00:00) How Health Insurance Was Broken Over The Last 40 Years (00:05:01) Why Self-Funding Has Exploded Since the ACA (00:09:58) How We Went From 25+ Carriers to Just 4 (00:12:56) The "Buca Box": Trapped with No Options (00:31:04) The Rise of Captives as an Alternative (00:40:31) Why Engaged Employers Win in a Captive (01:00:56) A Call to Action for Employers & Advisors Key Links for Social: @SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFunded Listen/watch on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02 Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286 Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/ Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/