Trading Secrets -  314. Steve Cain: $5.5T Healthcare Industry, Insurance Margins & The Future of AI

Episode Date: July 13, 2026

This week, Jason is joined by UnitedHealthcare California CEO Steve Cain for a conversation about the $5.5 trillion healthcare industry, why healthcare costs have climbed to nearly $17,000 per person, the misconceptions surrounding health insurance, the future of AI in healthcare, and what it takes to lead at the highest level of corporate America. Steve breaks down where your health insurance premium actually goes, the role employers play in choosing benefit packages, and why rising hospital, provider, and pharmaceutical costs have created major challenges across the healthcare system. He also explains why greater transparency and better alignment across the industry could help lower costs and improve the member experience. Jason and Steve also dive into leadership, making decisions under pressure, and Steve's journey from sales to the CEO level. Plus, Steve reveals UnitedHealthcare's plans to invest more than $1.5 billion into AI and how technology could reshape the future of healthcare. From breaking down where your health insurance premium actually goes to revealing UnitedHealthcare's $1.5 billion AI investment, Steve reveals what it really takes to navigate one of America's most complex industries, lead under pressure, and rethink the future of healthcare. Steve reveals all this and so much more in another episode you can't afford to miss! Subscribe to the Trading Secrets podcast! Host: Jason Tartick
 Audio: John Gurney
 Video: Marc Colcer
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Welcome back to another episode of Trading Secrets. Today we are joined by one of the most influential executives in healthcare and corporate America, Steve Kane, CEO of United Healthcare, California. United Healthcare serves millions of Americans and operates at a scale few companies in the world can match. From employer-sponsored healthcare plans to Medicare and consumer health services, Steve oversees an organization that sits at the center of one of the most complex industries in the country, And don't worry, we're going to get into it. But today's conversation is not just about health care.

It's about leadership, scaling massive organizations, making decisions under pressure, navigating public scrutiny, and understanding the business behind one of America's largest industries. We'll talk about Steve's career path, lessons learn, climbing the corporate ladder, how major companies think about growth and risk management and what it takes to lead teams at the highest level. Steve, welcome to trading secrets. Awesome to be here with you, Jason. This is awesome. This is awesome.

But before we jump into healthcare, right? Sticky topic, big topic. My wife now thinks I'm cool. Oh, let's go. I'll take it. I'll take it. I've been doing this for 25 plus years. She has never thought I was cool.

And I told her I was doing this podcast with you. And she's like, wow, I didn't know you were cool. So thank you. Honestly, I am honored. It is cool to see a CEO of such a large organization. Also have a little, you know, tied to reality TV before we dive into it. Like, you know, you got any favorite shows? Yeah, I mean, you know, Dancing with Stars, we talked about it before we kicked it off.

Let's go. I mean, that's a favorite from our wife and I. I'll tell you. And we were just saying we were talking about, you know, the new show coming out, you know, finding a pro or whatever that is. And so we're super excited about that. My wife, she's going to kill me for saying this. Yeah. But she's a bit of a junkie when it comes to these TV reality shows.

Oh, my gosh. And I find myself get sucked in. You know, it's late at night and you come in to bed and you're like, wow, I guess I'll watch this too, whether it be below DAC or what have you. So, yeah, we're in. We're all in. See, guys. Everyone listening, even the biggest CEOs out there, they're still watching this stuff. Of course.

You know what I like to? You're already building credibility in my audience because some people come on here and they're like, oh, my wife watches it and I don't know anything about it. You're like, no, I sit there and we're watching. It's a beautiful thing. I might pretend like I'm not like you. Yeah, yeah, yeah. But I do.

I love it. I love it. All right. Well, let's get to something a little bit more complicated. Let's do it. Healthcare, wild industry, one of the biggest industries in the U.S. economy. And when we go back, we roll the tapes back to your career track. I'm always fascinated how people got to where they got

and why they're in the industry that they're in. So I looked at your LinkedIn, Boeing Green, you're studying sports management. How and why healthcare and what has that process been like? Yeah, it's really interesting. So for me, I graduated from college. I was a college soccer player, a D1 soccer player. So, you know, I enjoyed my time in college.

Of course, a love athletics. I thought I was going to go into sports, you know, some level of sports. And what my first career and my first job out of my school, was really tied to non-health care related. And then I got into health care and people said, well, why did you get in health care? And often, you know, you hear really great stories,

like really passionate stories. Like, you know, I had a sick family member and it really made a difference for me and I wanted to go make a difference in health care. Yeah. And for me, to be quite honest, Jason, I got into health care because I was living downtown Chicago. It was a really cool job.

And I thought, hey, you know what? I can pay my bills. I can go do sales. I can have fun. And so it really isn't like what got me into health care. I think the more important question is what's kept me in health care. Yeah. Right?

Right. Because 20 plus years, right? 20 plus years. And so, I mean, you teed me up there. I mean, what has kept you in health care? For me, as I've gone through 25 plus years of health care and I've seen all the different iterations and where we are today. And yeah, there are a lot of things that are confusing and hard and difficult.

And health care can be scary when you have to access it. We all know that. And so my job is I've gotten into different leadership roles. I've really kind of grounded myself in. I want to be a connector. I want to be a connector. You have all these different constituents. You have providers.

You have hospital systems. Regulatory. You have employers. You have brokers, consultants. And so you have this system that's very complex. And I feel like my job, as CEO of California, is really to try to be the connector between all those different constituents and stakeholders to really make sure that we're aligned.

to create a better system because that's really what we're all trying to do. Yeah. It's not because people aren't trying hard to make health care better. Yeah. Everyone's trying hard. But it's not about trying harder. It's about doing this smarter. And so if we can do it smarter and a big key to this, Jason, honestly, is just alignment.

We've got to have better alignment between us and all of those constituents. Because ultimately, when you think about health care, we don't own health care. United Health Care doesn't own all the pieces of health care. It's our job to take all these various pieces of health care, the hospital systems, the provider groups, pharma, put it all together in a package that makes sense for members on when they access health care to make it affordable and easy and make the experience good. So that's our goal, right? We have to package all that together and then put it out of the marketplace and drive members

to the right care at the right time. You can imagine why it is so complicated, right? Because it impacts from day one to your last day and even beyond your last day, the family's behind. Like, healthcare just touches every single person with a heartbeat in the United States. Correct. And then you think about all of the layered pieces to that components. And then, of course, being in California, one of the largest, the largest state that has the most impact on trends and things like that. So so many moving parks, we'll talk about those.

What would you say when you look back at your career 25 years? Sure. Even when you're here today, one of the biggest complications and things that you continue to work through is creating consistency and clarity through all those channels while making such positive impact. What do you think over 25 years has changed the most? Yeah, it's a great question.

You know, we are certainly evolving and running head into AI, right? And so where I started 25 years ago, there was literally, you weren't even on a computer. that had windows, you know, to give it perspective, right? And think about the cost of health care. So, you know, the big macro numbers, which don't mean a lot to people. And, you know, but you do say them just to give it scale. I mean, the U.S. economy spends about $5.5 trillion on health care.

It's about 18% of our economy. But the number that makes even a bigger impact is think about some of your listeners. So if you have a listener today who's 26 years old. Yeah. When they were born, health care costs. under $5,000, you think about per capita. That's what the total health care cost was for Americans was about $5,000. Wow.

Today, in 2006, $17,000. So you've got almost a three times escalation and cost for Americans. But what's the key issue there, and what we're all trying to solve for is that when you think about production, you think about innovation, you think about care delivery, you think about better experience, it's lagging behind that cost trajectory.

Now, we've made gains in all those areas. I mean, medicine is advancing, innovation is advancing, AI is advancing, but it's still lagging behind this cost factor. And so those are the things that we're really focusing on is we've got to catch up and actually try to surpass that cost basis in order for us to make a real difference. And so that's what I've seen the most is escalating cost, but at the same time,

we're not seeing the outcomes or the value of the cost. It's one thing if I told you, hey, Jason, you're going to spend more in health care, but man, it's going to be a 10 times better experience. Yeah. Or you're going to have 10 times a better outcome. And today, it's just not happening. And that's what we've got to work on. Interesting.

So if you fast forward, we went backwards 25 years. If you fast forward, let's call it five years, under your leadership, the things that you're getting to do, what is like best case scenario look like for some of these complications and these problems to solve for? Yeah, it's a great question. So it's not, to your point, it's not where we were. where it's where we're headed. Yeah.

And where we're headed, I think, is a new model. Because today, your listeners, certainly the new generation that's in their workforce, they don't look at health care the way that I looked at health care. You know, when I was growing up, you went to brick and mortar, you made a doctor's appointment, you went to the doctor's office, and God forbid, if you had to go in the hospital. But those are the things that you did. And today, the younger generation, honestly, they don't know the difference between primary care, specialty care,

urgent care, an ER visit. They want care when they want it. They want it to be digital. They want it to be able to go through a front door. They want it to be easy, understandable.

They want it to be as affordable as possible. And so that's where it's kind of headed, in my opinion, it's going to be kind of a modular, I think a product that's going to kind of balance. You're going to have AI. You're going to have triage. You're going to have the ability to have virtual visits,

which we do today. And you're still going to have to have brick and mortar, meaning you're still going to have to go into a hospital. You're still going to have to go in and see a doctor. But I think trying to connect all that connective tissue between all these different ways to access care is something that we're really, really working on. That is so cool. And I know we have CEOs that are listening to this. I know that we have entrepreneurs. I know that we have employees that are listening to this.

And they'll find so much interest in some of the conversations regarding health care and the specifics. I know they'll also find a ton of interest of just peeling, stepping back a little bit, I think whenever I have a CEO in the room, they always are just curious. Like, what is it? Because they're all trying to differentiate themselves. So we'll talk about consuming health care and buying health care and all those things. Right. But they're trying to differentiate themselves. Their small businesses, their leadership styles, and all of those things. What is it that you think, the number one thing you can attribute

to your leadership style or your success within corporate that has led you to get where you have gotten in 25 years, becoming CEO of? of one of the largest companies in this space in an industry that's running almost 20% of the U.S. economy. There's two things I'm going to say. I'm going to back up for a second. When CEOs in this country, they have to be involved in health care decisions. And one of the things that I would tell you and your listeners is that CEOs, whether it's not running a health care company, it's running a company. Those companies have benefit packages that they offer their employees. Most of the time, those benefits are. are probably the second biggest cost for them, right?

After employee costs, right? The second biggest cost is benefits. And what we too often see is CEOs who are not engaging in that process because they think it's just a cost center on the ledger, right? And they just think it's a commodity. Sure. And that could not be further from the truth. And so I think getting CEOs across the country

as it relates to the benefits that they're offering their employees, they've got to be engaged. You think about California. I'm in Northern California, ground zero for tech companies. There is no way tech CEO of, let's say, a thousand employee group or company would ever not be involved in a decision around technology or platform or what they were bringing to the marketplace. Of course. They would never, right? But my question is, why aren't they more involved with the second biggest cost item on their ledger?

And I think it's because it's just looked as a commodity. and it couldn't be further from the truth, because it's how I see it, picking a benefit package that matches your culture, that kind of lines up with your vision as a CEO, and, Jason, you know this, like, especially in California, you know, a really smart benefits package,

you retain top talent at drives employees satisfaction, and you actually can go get new talent. So it does matter. So that's number one. When you said CEOs, that's the first thing that sparked me. came to your mind. So your second question was, or I think I put that in there.

So I'll answer your question. Yeah. So for me, I did not grow up as an executive in the business, right? And so for me, I grew up as a salesperson. For many years, bag on the shoulder, out in the marketplace, meeting with employers, meeting with brokers and consultants, selling our values story, learning the business, understanding, you know, what works, what doesn't, all the pitfalls of sales, right? and sales can be a ton of fun, and I loved it.

Yeah. But I think if you ask me, okay, what are the two or three things, attributes that drove you? I think for me, it's a couple things. It's being authentic and it's being vulnerable. Those two attributes really matter a lot. And I think, you know, those two attributes, if you can pull that off,

no one wants someone to be fake. Yeah. And we all know when somebody's fake. You can smell it from a mile away. But if you combine, like, being authentic, being vulnerable. And then I think part two of that is it's going to be yet to do more than that.

So step two of that is you got to grind, you got to be a grinder. You know this. If you want to be successful on anything in life, you've got to grind away at it and you've got to be consistently engaged. And if you can do those things, be a student of the game,

really open up your aperture, want to understand the business, understand the importance of culture, understand the importance of having a really good team around you, that's what makes you a successful leader. And so forget about the title. It really is about what do you want to be, who do you want to be, and what are you willing to do to get there?

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This is what we're doing with pricing. This is what we're doing with strategy. You as a new employee or a young employee trying to work your way up, you have no control over that. But what you do have control over is, are you prepared every day? Do you know your business? How are you showing up? Do you look the part?

or you have energy, are you consistently engaged? And that's a big one for me. Don't come in and out of engagement. You know, you and I were talking sports a little bit before this. And think about the great athletes, Jordan, Brady, Michael Phelps, never, ever, ever, not engaged. Always. Always. From early days to late nights, 24-7, they're always in it.

I think it's actually really cool. Let's go with this because you answered in two parts. I want to follow up in two parts. I think it's really fascinating that as a CEO, you were on the ground, right? Like, you were actually talking to these, you know, CEOs of probably all-sized companies, not sure what companies we were selling into. Sure.

But you were meeting with all these different businesses. You're selling these different benefits packages. You're selling. Like, there aren't many CEOs that have the background of selling. We have so many CEOs that come on here that have the background of consulting, Ivy League, to NBA, to jumping to executive leadership. Finance. Yeah.

So it's so refreshing because I do feel like employees and consumers of spaces and industries, they are yearning and they are really dying to get to know a company that is showcasing authenticity, that has a leader that is being vulnerable. And I think that's fascinating. Let's go back to your first part of the answer. CEOs and employees. I think there's a lot of leaders of companies that listen to this podcast. There's a lot of employees that listen to this podcast. You had suggested the 1,000, example of the thousand person tech company, right? The CEO is all in on the tech, right, as they should. But where they're missing is one of their biggest line items that impacts retention, growth, and culture. That's health care. What is your advice

to anyone listening to this that runs a company that's overlooking that line item? What should they be doing differently? And as they're making big purchase decisions for their company as to who they go with and why, what are things they should be thinking about that maybe they're not thinking about. Yeah, it's a great question. In today's world, what happens most of the time is it becomes spreadshutable. So what happens is what your listeners might not know is that every one of those companies that are out there that have insurance has a consultant or a broker. Yes. We work through those consultants and brokers first. So those brokers are hired by the company to go out and say, hey, help us understand what benefit package that we should have.

And in most cases, especially in that mid-market segment, what they end up doing is there's a lot of great brokers out there and we would not be where we are without their partnership. But one of the things that happens is they go out, they put all of us on a spreadsheet, and most of the time, the low number wins. It's a bidding war. It's a bidding war. And the low number, as you know, just because you're the cheapest, the long term, so you think about the long game, cheap doesn't always mean the best.

Cheap doesn't mean quality. Cheap doesn't mean the best performance. Yes, affordability matters in health care. We all know that. but you've got to be able to as a CEO or a leader of a company, if you just get underneath the covers just a little bit, working with your benefits team and your, you know, CHRO and others, and you understand, okay, what are our options?

All of us, every single payer has a menu of options. It's like TGIF Fridays, right? It's not a little, it's not a little boutique restaurant. Yeah, yeah, yeah. It's a Friday's menu. You got into a diner, you got it all. And you can pick all kinds of, levels of benefits that you want to put in.

Sure. And they all have a different price tag. And they all have a different experience. Because one of the things that ends up happening, just the other night. So my wife and I had our neighbors over for a glass of wine. Okay. And my neighbor said, God, I love my insurance. And I hate my new insurance.

And he works for a big company in Northern California. Yeah. So this is not a small little startup company. Sure, sure. And it hit me. I said, well, why do you, why did you say that? And the reason he said that, and this is, happens most of the time when people say that, especially in the commercial environment,

when they say I can't stand my insurance, they're saying that because they don't like the benefits or they don't like the contribution that the employer is making them pay. So meaning, hey, I don't love my benefits because I got a $5,000 deductible. I've got a $8,000 out of pocket and I've got really high copays. So that's called first dollar coverage, meaning that that member has first dollar coverage that they're going to have to put out of their pocket. Whereas another employer might have really rich benefits, $250 deductible, $1,000 out of pocket. So, again, really low cost share. So people, I think the one thing that happens is, is members think, and the public think,

oh, I don't like X insurance company when, in fact, you don't like the benefits your employer chose for you. That's an eye opener, right? That's an eye opener. Your employer made the decision, and that's one of the things that I think we've, got to figure out how to get underneath that because an employer, let's go back to that that company that's 1,000 employees. So they have 1,000 employees, but we're covering probably 2,000 members because we're covering their wife, their daughter, their kids, their boys, all of that. So it's not just the employees that are impacted by this, it's all of their families. And when somebody

in a room makes a decision based on cost alone and not looking at all the pieces that fit underneath the benefit plan, are you really really? doing what's right for the entire population. Because if you're just going to look at it from a cost perspective, it's really hard to make sure that you're going to kind of fit the needs of everyone. Now, no one plan is going to fit the needs for everyone. But that's the goal, I think, United Healthcare and others is, back to your question of, okay, what are we thinking about the future, is how do we make it more modular,

which we're doing today, which is you have a base plan, and then you can go grab the things you as a family, let's see, have a special needs child. It's something unique going on. Sure. We have products that you can pull off the shelf. You bolt that on, and now you're solving for what you need to be solved for it, and you've got the base plan. You know, one of the questions I get asked often is,

what is the biggest misinformation or misconception? And that's one of them is, remember, your employer most of the time in group insurance, which is a lot of your listeners, they're making the decision. I didn't make the decision that your employer did. Sure. And I'm not trying to say that we don't have a part of all this, but we have a large, large, large menu of items. And, you know, employers are constrained too.

They have cost objectives and they have cost pressures, and they've got to put their health care costs into that equation. But that's a big one. That makes a lot of sense because the employee who's dealing with the burden or maybe like the lack of benefits based on what their employer decided on due to cost, then has a connected dotted line to potential reputation risk or noise that the actual insurance company has to hear when there are other options, there were other offerings, it just might have not been what their leadership decided for that company.

And I think if you're a leader of a company, thinking about that at a whole different level, that your impact in that decision is impacting how your people perceive insurance, how they perceive their costs, how they perceive working for you, how they perceive you make decisions. and people are talking about it. And I think when you look at AI and technology and social media and all these things, I think as someone who employs people, I need to be aware that the decisions I make

is going to impact their perception of it. And everyone now has a stage with social media and other things and LinkedIn is becoming a social media platform. People speak about this. They talk about this. And I think leaders of companies need to think through it. I want to go to the other side of the equation, though, right? So I have a lot of people that are employees right now

that are searching for jobs, that are interviewing for jobs, they're talking to their employer, they're asking questions about benefits. What are some good questions they should be asking potentially future employers or their current employers while they're doing their annual review about the insurance packages, the health insurance coverage, and what are things that they need to be kind of almost putting the pressure on as far as an expectation as an employee for a company? Yeah, it's a good question because depending on your situation, especially if you're coming

in as you have family or you yourself have special needs, right? Yeah. So I think it's some of the basics, right? What is my contribution? So let's just keep it as you're single. And so you're going in and you have single coverage. You know, employers have the right to give everything up to 100% of contribution, meaning they're paying 100% for the premium that we charge.

It could be anywhere from 50% to 100%. So that has an impact on your paycheck. That has an impact on what they're taking out every two weeks. So that's number one, contribution. That's simple enough. Number two is, I want to see a copy of the benefit plan. How comprehensive is it? What does it look like?

What is that cost share? Is this a really, is this an HSA plan? Is this a high deductible plan? Is this just a standard PPO? Is it an HMO plan? Do I have a gatekeeper? Do I not need a gatekeeper? Do I have out of network coverage?

Do I not have out of network coverage? These are all the questions you need to get involved in. Those can make a difference, right? Those things I just said, right? Around cost share, contribution. What does the network look like? How does the network operate? Let's say I travel all the time.

I want to make sure I have a wide national expansive network. What if I have a family and I've got kids in college and I want to make sure I have them covered? I want to make sure that when they're in college, they have coverage. I can't do that if I choose a different plan. There might not be coverage outside of a given area. So those are the things that I would really harp on is just ask those basic fundamental questions. And I mean, let's face it, Jason. with AI today, you're going in to meet with an employer for an interview or ask questions.

It doesn't take but two seconds to throw that into co-pilot or chat GPT. And they'll give you 10 great questions to ask. Just do that. And you'll be set. Just do that. And also, I think from this interview, what you'll also learn is if you're talking to someone at executive leadership and you ask those questions and they don't know the answers, they're doing specifically what you had said most CEOs are doing, which is they're not even

paying attention to it. maybe someone in HR or procurement is actually making the decision based on price point. So I think that just provides you a lot of information on where you're working and that impact. And it's the layers within health insurance. It's just wild how a conversation employee can have with someone at leadership of the company can tell you so much about that company based on what they decide to do in health care and the benefits they offer. One thing I love about summer is just how easy everything feels. The days are a little more relaxed.

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Automatic Bitcoin purchases on Cash App have zero fees and zero spread, which matters if you're buying regularly. I've used the Cash App before. It is so easy to use to track. your money, savings, invest, all the things. For limited time, new customers can get $10 added to their balance. You'll just use code Bitcoin 10 when you sign up. And don't forget this part. Send at least $5 to a friend in the first two weeks. Terms apply, Bitcoin services by Block Inc. See the Bitcoin Disclosures at cash.at-backslash-legal backslash podcast. Before I start going into some other areas of healthcare that I want to ask you about, I want to circle back to that first question of

leadership, how you got there, vulnerability, the work hustle, all the things. What would you say like your leadership style is and how has that become effective and just motivating, inspiring in a time where I feel like people right now, if you look across the board, employees are, there's a little bit of lack of faith right now within their companies. You're seeing people switch their positions at all-time highs. Youth unemployment's a little low. So what are the things that you do to keep people inspired and engage and what's your leadership style specifically. Yeah, that's a great question. I think first and foremost, I think about,

you know, I love analogies with sports. Yeah, me too. You've got to have a great line. If you don't have a great line in football, you're not going to be able to run the ball. You're not going to pass the ball. So it really does start with making sure you surround yourself with a really good team. And so that, I would say that's my first priority as a leader, is you got to make sure you have a team that's ready to go with battle for you. The ability, they have the ability to go perform, the ability to make a difference, the ability to go out in the market and really drive change. But my leadership style, I think I try to blend someone who's very supportive,

someone who's really, really engaged. There's nothing I wouldn't ask my team to do that I would not do. And so I really try to blend accountability because ultimately you have to be results driven, but doing it in a way that matters. And this is how I think about it. At the end of it, we've got to be performance driven. We've got to hit our metrics. any business, I don't care who you are,

you would be fooling yourself to say that's not the case. But the journey on how you get to the end result or the end performance or the output matters. And so I want to make sure that the journey for all of us and my team and anyone I'm touching internally or externally, that the journey feels right and it feels aligned and it's partnership-oriented. And if you don't do that in any way along the journey,

you're not being a good listener, you're not being supportive, and more importantly, not pushing when appropriate. I mean, we've talked about sports. Like, some of my best coaches push me beyond where I thought I would go because they were hard on me,

but they were also the same coaches that were hard on you, and then at the end of that practice, our game would put their arm around you and say, awesome job. So you really have to blend, I think, as a leader, you have to blend that ability to say,

I'm going to push you hard, but I'm also going to praise you, when you nail it. Yeah. It's cool to hear that your leadership style is aligned with journey. Because one of the questions I had for you is, how do you, in this space that you're operating and leading, you have quite the journey to balance, right?

You have, we talked about the cost that people are enduring and the increase of it across the board. You as a leader of a privately, publicly held company, but in the private sector, you have to manage profitability, innovation, balance sheets, all the moving parts, while also dealing with the public responsibility of millions. So it's refreshing to hear that journey is your leadership style

because it's quite the journey that you have to do. How do you execute that journey in this industry? And how do you manage all those things when costs are going up, profitability, public responsibility, while dealing with continued building trust and communication with all these layers? How do you do it? Yeah, I think about the movie Apollo 13.

Oh, great movie. I love your analogies. I'm a huge analogy guy. I love a good analogy. Yeah, I love it to it. Actually, I use it for chat GPT or copilot. I'm like, if it's something I don't understand, which by the way, happens all the time.

You know, health care is complex. And I'll ask it, like, put this in like an analogy that I can understand. And then I'm like, boom, I got it. It can be really complex. Good idea. But I really think about, you know, the part of that movie that we all know, right, is work the problem, right? Everything was going wrong in Apollo 13.

and it kept going wrong, and it almost seemed impossible that they were going to get back to Earth. But Tom Hanks' character, what he was grounded in was just calmness, work the problem, urgency, use facts, use data. And so I think that is the key for me is that, you know, as a leader, and literally as United Healthcare even broader, we want to make sure that in those moments where the pressure rises, you've got to make sure that you are grounded in the facts because pressure can drive you into a corner and it can shut you down, it can overwhelm you. So you really kind of have to break up whatever's happening,

put it in the right chunks, and work them until you've got it solved. And you've got to bring people around you. I think often, you know, people have a misconception of CEOs, like, oh, they're going to figure all things out. It's not true. Like, you've got to put really smart people around you. you got to put people in a room and figure it out. And, you know, for your younger listeners,

when things get pressurized as a leader or a young leader, that's when people are going to have their eyes on you the most. That's when it happens. Because they're looking at you to be calm under pressure, to do the right thing, not to go over your skis on, you know, not being able to handle the moment. And handling the moment and handling the pressure is incredibly key.

Our business is so complex. you think about you've got massive federal and state regulatory issues happening all the time. You've got provider issues. You've got hospital issues. You've got pharmacy issues. All of these things come together. And none of it we own. And we talked about in the very, I don't own any of that. Not only do you guys not own that, you're up against, and you correct me if I'm wrong, but you're up against some of the biggest and strongest business brains in the world starting to own those, right? Like when you look at like private equity getting involved. So now you're having your working partnership with some of the biggest and best brains in the world. Right. Yeah. And think about

this for a moment. If you just kind of break down the health care dollar, right? Because here's another misconception. So one of the misconceptions we talked about was, hey, people, when they say, I hate my insurance, you know, you probably just don't like your benefits. Sure. Because for most of us, right, and I'm not saying that health care is easy. I'm not trying to say it's not complex because it is. But for a lot of us, you know, we know how to access care. For those of us who are lucky enough to be healthy, you know, you're just kind of accessing care when you need it. You know how to do it. And it works for 85, 90 percent of us. It really does. For sure. But when health care gets super complex and it gets sticky or tricky or you are you having a, you know, at a really

sticky event, medical event, that's when we need to do a better job for people because that's when they get lost in the system. They get overwhelmed by where to go. They get overwhelmed by the administration process. They get overwhelmed by the bills. And it's taking care of that 10 to 15 percent that are just stuck in the health care system and our ability to make sure to get them unstuck, navigate them through that. So we work our butts off on doing that.

AI will help that, right? There's certain navigational pieces, that top level, that first six inches down into health care. AI is going to be great for that. So I think about that. And then I think about the other misconception is the health care dollar. People just think that United Healthcare that we just, it's the prices that we charge or the premiums that are on the street are solely derived from us. But what is the real truth is that, and I'll back into this, take a single person's premium of $700. $89% of that $700 is not my cost, as not tied to United Health Care.

No way. So think about that. So $700 premium, $623 is just me taking the costs that are being charged to me through providers, hospitals, medical groups, pharmacy, ancillary coverage. All of that is about 89%. Wow. The other 10 or 11% is payers like United Healthcare. And in that 10 or 11%, you've got to keep the lights on. You've got to have an admin.

You've got to have a network. You've got to have all the resources, innovation, all the things we do to navigate members. And our margin is about 3 to 5%. Wow. That's our margin. So when you think about the health care dollar, that it is not that United Healthcare are big payers are the ones that are just waving a magic wand and coming up with a premium. If a hospital is charging, and let's break that down even further.

Yeah. A hospital in that dollar is 37%. of the cost. I'm 11. Providers in that are 15 to 20%. I'm 11. Pharmaceutical costs are 15 to 20. I'm 11. So even if you remove me, Jason, if you remove my, if you remove my 11%, and let's go back to that number I gave you, $17,000. 17,000 at the beginning, right? Right. First 5,000. Versus 5,000. That's where we are per capita. You still have you still have a $16,500 problem. So removing me doesn't solve the cost problem.

And I would say removing me actually is going to increase costs because of all the things that we do around making sure that you have, you know, the right navigation, right cost, right network, making sure it's safe, making sure providers are doing what they're supposed to do from a quality and an output perspective. So that's one of the other misconceptions, just how the hell are these premiums derived? and you see it, I see it on social media. I can't stand X insurance company.

It costs so much. Oh, yeah. Well, the hospitals in this country, to go back to that timeline of 2000, 2020, what would your guess be on how much hospital prices have increased? From 2000 to 2026. Let's say I'm going to just use the benchmark you provided with insurance and say 3X. Exactly. So it's a little less than 3X.

Okay. So that's how much hospital costs have increased in this country. In 26 years. All of that cost. So when you think about the margin I told you about, we're three to five. Three to five percent. Big pharma. Multibles of that.

Technology. Multibles of that. Big hospital systems. Multiple of that. Right? And so we've got to take all of these players, build this, build the premium up with these margins and make this affordable. Now, we're not sitting on the sidelines on this, and we have a big role to play. Sure.

And we've got to do more and we've got to do better. And it's our job for the American public to go out and all these different players that make up this calculus. It's our job to get more aligned and make sure this incentives get aligned. because this misin-lined incentives is one of the biggest things we've got to figure out in health care. Yeah. Is everyone's got their hand in the pot. Everyone's got different objectives,

and we're losing sight of one big thing, is that I can haggle all day long with a big hospital system over, you know, 3%, 4%, 5%, you know, what is the annual increase going to be? Yeah. We've got to stop haggling over a couple percent, and we've got to start figuring out where the value is in the equation. and how we both can agree on where we can extract value.

And if we can extract the right value, that lowers that cost basis, which lowers premium, which lowers that contribution we were just talking about. Now that same young person is paying less out of their pocket. So it's just a, it's a, it's a 360 degrees. And if they're paying less out of the pocket, that means they're probably going to access health care better. They're going to access it when they need it. they're not going to have an issue with their, you know, their own savings account.

And same with employers. Make it cheaper. We got to make it cheaper. We got to make it easier. Access has got to be better. And so that's kind of how we think about it. Yeah, I think, but it seems like also part of your job with all these misconceptions is education. Yeah.

It's like it's education through some of these numbers. Like these are numbers I had no idea about. And if you think of majority Americans that aren't learning the basics of finance within their school system, when you start bringing complex matters like healthcare into the equation, you're going to lose so many individuals and people are going to just turn their head and start pointing. And when you start to hear that your margins are in the 3 to 5% range and that, you know, healthcare is making up 11% of the total cost, that's like the education. That's the misconception that needs to be cleared because obviously it's easy to mislabel,

but one of the things I love saying is like numbers don't lie. Like the numbers don't lie in that equation. You talked about it a little bit of what your role as a CEO is to help continue to try and reduce these costs and start working with your other partners and finding ways to make it easier. Do you have any tips or tricks or advice for the person that's listening that feels like, okay, I understand that's what they have to do. I now feel educated that I knew this because I didn't know it. Now I do. Is there anything I can do? Do you have any tips or tricks for the people that are listening?

Or would you say the number one thing to do at this point is go to do? your employer, talk to them about all the moving parts that we discussed. You know, I'm going to give you an answer that's more tied to care. And my tip is in relation to your care, because if you don't care of yourself, you're doing the right things for yourself, you know, you are going to see expenses. That's just the way it goes. Preventative care, right? The more healthy you are, the less you're going to pay out of pocket, and that's just a fact.

Yeah. So my biggest advice for young people is you're healthy, you feel like you're invincible today. But make sure you go make a relationship with a primary care doctor. That's a good point. And that could be virtually, right? I think ideally, like, we still are humans. I think it's still something to go meet somebody and meet somebody eye to eye. And so my advice is go build a relationship with your primary care.

That primary care ends up being your quarterback of care. Sure. Right? And the stats don't lie here. You know, when members are attached to a primary care and every relationship with their primary care, they're going in or doing their annual visits, they're getting their checkups, they're getting their blood drawn.

We know for a fact, the outcomes are better. We know for a fact those same people make better decisions and it's less costly. Access is easier. Because, I mean, you know, there's numbers,

all kinds of numbers out there. You know, you not having a relationship with your doctor, and let's say, you know, you skip your screenings for several years, and boom, you've got aggressive colon cancer,

if you get colon cancer and we detect it early, you have a 90% five-year survival rate. Wow. Yeah. If you detect it late because you're not keeping up with your health, it's a 30% survival rate for five years. And so those are huge, and I could give you 25 more of those. Yeah.

But the point is you've got to get engaged. If you get engaged, you're going to have better outcomes. And we see it across the board. Yeah, preventative practices, is making relationships with your primary, going to see them routinely. Those are, those are the things that matter. And those are the things that sometimes you get busy and you forget to do. You forget to do it.

You got to make that stuff a priority. One thing I want to ask is you have to make these hard decisions, right? You talked about some of the relationship components of the cost and some of the layers that you have to get involved in. What is, like, how do you, what is your tactic for making hard decisions under extreme pressure? So right now you have a big decision tomorrow to make this is a hypothetical, and you know that it impacts millions of people. What are some strategies you utilize to be in a hot spot that you got to make a tough decision

while making the right decision? You know, I for years did triathlons. Okay. And I was lucky enough to do a few Iron Man's. Dang, let's go. It's cool, right? Watch his reality TV does Iron Man's. I'll tell you what.

Did Iron Man. Did Iron Man? But still, you check the box. But yeah, I checked the box. So, but I only bring that up because when you think about an Ironman, it's daunting when you think about it in its entirety. Totally. It's like, whoa. It's great.

Just the training for it. You can't get your arms around it. Right, right. But if you break it down into the training, into a swim and a bike and to run, and how you're going to execute each of those, it becomes a little bit more manageable. Yeah. Right. Yeah. So my point on that was not to brag that I've done Iron Man, by the way, it sounds like I did.

My point on that is you can't get overwhelmed by the enormity of it. I mean, the example you gave me is a million members and be like, wow, impacting a million members. Could be tens of millions of members when you think about more broad UHC. And so here's a trick that we do. And this is no BS. Oftentimes when we're thinking about a big strategy or something we're going to roll out, how that's going to impact, is you sit down and you ask yourself, this strategy that we're about to roll out, what would my mom or dad think about it?

what would my brother or sister, my children, and my friends think about it? And if the answer is, man, I'm not sure they would love this. I think this would be an abrasion point. I think this would be tough. I think it would make it tougher for them to access care or make it more costly.

Then we often press pause. We take a step back and we go back to the drawing board. And I think that's what you have to do. So I think we think about the big pressure moments and I think you've got to break it down, we talked about earlier, you've got to make it manageable. And then when you're working through the strategies that are causing the pressure, you've got to have the ability to, A, if you need to take a step back, do it and do it quickly.

And if you have to make a decision, you make the best form of decision you can based on facts and data, and you move forward with it. You know, not every decision works. You know this. But the key is you've got to make it. And you learn from it. And if it fails, you learn from that. And, you know, I think, as you know, failure a lot of times can be the best medicine for how to be successful the next time.

Just don't fail twice. Just don't make the same mistake twice. Exactly. But, I mean, you know, you've got to make decisions. And that's how I think about, you know, big pressure moments. The fastest growing businesses aren't doing more. They're delegating smarter. Upwork helps you bring in expert freelance help fast so you can delegate and keep moving.

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Keeping your composure, not reacting, responding. I think it's brilliant. That was a hypothetical. Now I'm going to give you the magic wand. And so if you could say, you give us the magic wand, what do you think is the, like, if you could fix one structural problem, I think we talked about a lot of problems and solutions today. I think we talked a lot of transparency and numbers, things that we can do and things

that we know are being worked on. You could fix one with a magic wand with like the U.S. healthcare system. What's an area you want to tackle? Yeah, that's, God, there's a lot I would try to tackle. I think we talked about that hospital piece, that hospital system piece. It's the biggest part of the cost equation. Yep. And we've got to do a better job on getting aligned with our hospital partners.

Okay. It is one of the things that I spend 50% of my time on in California is we have large, large health systems. You know, some are regional, some are larger. And my goal with those relationships is to build these bridges, right? They have their objectives. They have their own, you know, cost issues that they're dealing with and cost pressures that they're dealing with, for sure, especially in a state like California. But if we can find, back to my point on finding more value, more common ground, more integration,

our ability to lean in. And we have data they don't have. They have data. we don't have. And why don't we try to do a better job, which we are advancing, you know, this concept, just bilateral data and having bilateral data relationships. Like just think about pipes just flowing back and forth between payers and providers so that ultimately the point of that bilateral data going back and forth is to make sure that we can guide members more appropriately, that we can put members in the right care setting more often and make it easier. That this whole concept

around value-based care. You've probably heard that buzzword. It's a big buzzword. It's everywhere, yeah. It's everywhere. And it means it's like a snowflake. There's a thousand different definitions for it. Sure.

And if you asked a provider what value-based care was, they'd give you a different answer. If you asked a big payer, they'd give you a different answer. You know, for me, it's really simple. It's just getting aligned on how we're going to move someone through the system in an appropriate way to make it less affordable and make the experience better. that's really value-based care versus how we do it today. We need a bigger percentage of spend going through value-based care, and United's proud of the amount that's going through value-based care models.

Okay. And so it's really about just incentivizing the proper behavior. Yeah. Right? And so if you do the proper behavior and you get better outcomes, we're going to pay you more provider because they're better the total cost of care. So it's simple. It's a return on investment, right?

Yeah. And so that's what we really think about. is how can we continue to drive that alignment between the providers. If we can do that and quit squabbling over, you know, give you another movie reference, did you like Braveheart? Oh, of course, yeah. You know, it's that great scene where he's like, we got to stop squabbling over long shank scraps. Like, we got to quit squabbling over long shang scraps.

Yeah. And just make it easier. And I think having common data sets that we agree, because there's usually a lot of finger pointing. Yeah, for sure. Yeah, it's like, no, we don't believe you. Yeah. And then we say we don't believe you. And it's just a lot of back and forth and a lot of energy and time is wasted.

Sure. And it doesn't need to be that way. Yeah. I think, by the way, we're making really good strides in this area of getting more aligned and using data to make more informed decisions and stop all this finger pointing and abrasion point. So we're getting there. I think we're making the right steps. And we're making a concerted effort to build those bridges.

And honestly, it's such a huge part of what I do in California. and a lot of one of my peers do across the country is finding providers who are like-minded and have this vision of value-based care and let's get after it, let's partner and stop all the abrasion. You know who gets caught in the middle of it? All of us and all of us.

Everyone listening right now. So when a big provider and a big pair, you've seen the papers, they go to war over what is rates. Yes. Oh, right? And rates are important, right? We're going to make sure we do it's right for our members and our employers, right?

But in the end of, if we go to term with a big provider, who loses in that is the member. Right. Because now we've cut the string because we can't figure it out. Now we've cut the important string that that member has to their provider. And when you do that, that's just not right. And we're really, really trying to fix that. Yeah, I think that's also refreshing for people to hear that at the CEO level, when you guys are strategizing, the member is now. maybe it was, maybe what now seems like,

it's at the center, epicenter of how you solve. Right. How you solve for the current problems. Let's start with the member. And keeping the member at the epicenter of that seems like the solution. You should, I feel like you're on our marketing team. I mean, that's like, that's, well, I think that's what people kind of want to hear, honestly. Honestly, I think it's nailed it.

If you keep the member. You know, I think I want to hear right in the center. And then everything else circling around it. Yeah. You just, the North Star is there. Yeah. And knowing that when I'm asking you a question of take the magic wand and fix a problem, and the answer is, obviously there's many different ways and moving parts of your answer,

but the baseline of your answer is, we have to focus around what the member is dealing with today, the issues that they're dealing with, and then how we solve for that. And to me, that's the answer I want to hear, right? Like, as a member, that's the answer I want to hear. So that is the answer. That is the only answer. And there's like 25 other answers to that.

Yeah, yeah. But boy, if you keep that as a North Star, we have a real shot at fixing this. Then it works. And I think the education component is so important in this space because members don't know. I would love to see a study

on what we're talking about right now, a blind study, every American answer these questions, the percentages, the margins. You ready for this? Yeah. 75% Americans don't know what a deductible is. There you go.

See? And they don't know how an out-of-pocket works. So what we've done, I'm contractually obligated, kidding. But my CEO of United Healthcare of the entire organization he would be upset if I didn't mention a product that we've

launched that's called Sureist and this will be my only commercial part of UHC. No, I want to hear it. Let's hear it. It's getting at what we're talking about here. Okay. So Surest was developed in mind exactly what we're talking about. Have it be a digital front door. Have it sit on your phone.

It's all co-pay based. There is no deductible. Wow. So everything is co-pay based and everything is based on who's delivering the highest quality medicine at the lowest possible cost. But here's the cool thing,

Jason. This algorithm and this digital front door, you as a member, you can access any provider in our broad, broad network. You make the decision. So if you want to go to the academic center that's in your state or in your city, Vanderbilt,

you're in Nashville, something like that, yeah. You know, if you want to go to Vanderbilt, you can go of Vanderbilt, it might be a higher co-pay. Sure. It might not because what we look at is not just the unit cost, the contractual cost for a given procedure or accessing care. We look at the whole cost. So what are the outcomes, infection rates, readmissions to the hospital?

We look at all of those factors. And we put that insurer, which we call the product. And it allows the member to be really informed about the decisions they're making. So now I can pull it up, which I have sure. and I say, hey, you know what? I sprained my knee running. I need to go to the doctor. Okay, if I go there, it's 20.

If I go there, it's 40. Okay, now the doctor says you need an MRI. Okay, you can get an MRI at a freestanding clinic. That's, call it $800. Go to the hospital, it's $2,000. All copays. And so it's putting the power of health care in their hand. Yeah.

It's driving full transparency. Yes. Because we guarantee the cost. So if it's an episodic, you know, let's say a longitudinal care where there's multiple steps you have to take, there is no lack of transparency in what it's going to cost. I often say this. Like I was at the old, our grand old Opry hotel until I told you, right? Yeah, yeah, yeah. So by myself at the sports bar last night, having a beer and dinner.

And can you imagine if I said, you know, I'll have a burger and an IPA? and then she brought me the bill and it was $900. I would say... Such a good analogy. I would say, what the heck are you talking about? What do you mean $900 for a burger and IPA?

Right. And she's like, well, that's what we charge. Sorry. And by the way, you better pay it. That's what's happening today. Like, it's crazy. And so we've got to continue to

collapse this lack of transparency. Sure, this is just one example. but our ability to put the power of transparency in members' hands to make the right decision is so incredibly important so that it's not at the end of care that you don't even understand the cost. That's what really upsets people is, geez, I went to the doctor and all I had was the flu, and it cost me $600 and I spent 15 minutes with a doctor. Why is that? I want to be able to make the decision up front what it's going to cost.

me. And if I would have known I could have gone across the street and that doctor's office visit was $150 versus $500 because I went to a higher, higher end place, I would have made that decision. But if you don't give them the power to make that decision or the tools to make the decision, they're not going to. And that's historically been the problem is that all this has been, you know, kind of cloaked. And it was, well, I guess I'm just going to at CARES CARE and my co-pay's $25. But behind that, you know, it's been. that $25 is a much larger cost. The cost of that visit didn't cost $25.

It cost 25 times that. You're just not responsible for it. But your employer is and your plan is. And so the more that we make people make right decisions, the better off we are. Does that make sense? It makes literally perfect sense because there's so much confusion in this space, right?

I think that if I had to summarize when I went out to our audience saying that we're having you on, the questions that came in. If I could summarize them all, and of course they're all worded different, is it feels like a game, it currently feels like a game of roulette.

Like when I go to the hospital, it's like, I have no idea. I'll wait two weeks and then a bill shows up and it's like, what is going on? And when you say that 75% of people don't understand actually what the term deductible means, of course there's going to be confusion, frustration, and point the finger.

The analogy of the burger and fries being $900 or $9 and not knowing is so well said. And I think something like that does everything you said. It empowers them, to make decisions based on the information provided. The information that's provided to them is extremely transparent and easy to understand.

And then they can make the decision based on what makes sense. And I think the other thing, too, is we're kind of wrapping up here. We've talked about AI of what the next future. We've talked about the past, the present, and what the future would look like. And you've mentioned AI a lot. And I know a lot of my listeners use AI every day. And I know there's also fears around AI, right? But I think that while all those things are fair, increased productivity and potential fears with AI,

I think we have to see the good in what it could do. And when I hear about AI connecting to healthcare leadership to create streamlined transparency, to me that's beautiful, right? Like that is where I want the productivity of AI driving things to make it easier for consumers to be like, oh, I get it. It makes sense. Yeah. I'm glad I'm part of this equation.

part of the process now. So it sounds like that's what... Yeah, you nailed it, and I'll just give you one minute on it from my perspective. Yeah. Is AI today is sitting, I would say, you know, just an inch deep into everything we do, right? It's being bolted on to existing tech stacks. It's being bolted on to existing processes. And I think what we're doing at United Healthcare is we're making a big commitment that, you know, in 2007, you know, we're going to spend over $1.5 billion investing into AI. And not having it just be that bolt-on are sitting on top of existing systems.

Yeah. It's going to be really fundamentally changing the areas that can be changed. Because if you think about Jason, we're at the kind of the top of Mount Everest on what we can continue, the communities can continue to accept in regards to how much health care costs. Sure. The premiums at an all-time high. So we have to figure out a way to get costs and be more efficient. So get cost out of the system, be more efficient.

And the way we're going to do that is really advance AI and a much more thoughtful, direct, and a little bit more of an aggressive way to get cost of the system. Because if we can extract in the industry, I'm not talking about United, in the industry, tens of billions of dollars. And that's out there. And it's sitting there. You think about claims processing and advocacy and all the things that go into all of that. It's not care, right?

We're not saying it's going to make care decisions. This is just the meat and potatoes. Let's call it to keep it simple. Admin. Sure. Admin. You extract all that cost. You lower that, what we talked about. You start lowering that cost basis.

You lower premiums to make health care more affordable. That's the goal of AI. I love it. There is some optimism out there for AI, everybody, and it's coming soon. It's coming. All right. Well, Steve, we've got to wrap with a trading secret. Every guest comes on.

They give us one trading secret. So it's specific to your career, track, your industry, your life, the things you're working on. What is one trading secret? you can leave us with. You know what I would leave you with? Let's hear it. I'm 57 years old, and I would say the most important thing I do for myself in my career is I stay fit and I stay healthy. I really am a big believer in, you know, if you have a healthy body, you have a healthy mind. And so I make sure that I really take care of myself. And so that's my secret tip is that don't allow yourself not to stay fit. It'll make a difference. I like it. I mean, I've

heard you on other podcasts and seminars talking to about how health care starts at home. We're hearing how progression within your professional career and your health starts with work. It's wild. When you just put in the word health and health care, the amount of dotted lines to every single aspect of your life, connect to those. Last thing before we wrap, you say stay fit. Give us one trading secret. Give us a specific thing.

You got an eating hack. You got a running hack. Is it a workout regimen? What is one thing you think people could do? I was for 30 years an avid runner. Okay. And I was a decent swimmer, decent cyclist, but avid runner. And, of course, being an avid runner, the older you get, it's hard.

Yeah. And so the tip I would give you is, I love swimming. Okay. Get in the pool. It's such a great exercise, right? You never get out of the pool and be like, man, that sucked. Yeah, it's a good point. It always feels really good.

It's just hard getting to the pool. Exactly. Getting in the pool. Yep. Getting out of the pool. All of that. But, man, I love it. So my tip on staying fit is getting the pool.

Getting the pool. It'll work the cardio out. easy on the joints. Steve Kane, thank you so much for Trig Secrets. Where can everyone find everything you have going on and United Healthcare? UnitedHealthcare.com. We're all over the place. You're not going to not see us. We're all over social media. So first of all, I want to thank you. This has been awesome.

I really enjoyed it and I hope we can do it again. Amazing. Steve Kane from United Healthcare. Thank you for United Health Care. Thank you.