In 2009, I wrote a book called Get Off The Dime about a problem that seemed obvious to me then and seems even more obvious today: American employers were spending enormous amounts of money on healthcare without developing the sophistication necessary to understand what they were buying.Nearly two decades later, the title remains relevant.
The difference is that the stakes are now considerably higher in the age of AI.
U.S. employers are facing healthcare cost increases approaching or exceeding double digits. WTW expects employer healthcare costs to increase by roughly 11 percent in 2027, which would represent the largest increase in more than two decades. Aon is projecting a 9.5 percent increase. Either number should get the attention of every CEO, CFO and corporate board in America.
For years, companies could tolerate healthcare increases of 5 or 6 percent. The numbers were large, but the impact on earnings per share was often small enough that healthcare remained largely an HR issue. Above 7% was when it staotobhitbthe radar of the CFO and of course it depends on the industry and profit margins.
Healthcare is now large enough to materially affect profitability. We are back to square one.
What is remarkable is that we have known this was coming for a very long time and yet there is no solution other than simply reporting in the numbers.
Twenty-five years ago, I started a company with the goal of helping large employers become more sophisticated purchasers of healthcare. We worked with companies ranging from McDonald’s and Transamerica to Google and Raytheon.
The premise was simple: if an employer is paying the bill, it should understand what it is buying and have the information necessary to negotiate intelligently. That principle sounds obvious when applied to almost any other industry. A sophisticated buyer should control price. In healthcare, the major dollar begins with the employer and of course Medicare.
It becomes much more complicated when applied to healthcare.
A company would never spend hundreds of millions of dollars on technology, raw materials or transportation without knowing what it was purchasing, what each supplier was charging and whether the product or service was delivering value. Yet employers have tolerated precisely that level of opacity in healthcare for decades.
READ: Sreedhar Potarazu | How 3 Harvard dropouts ‘Etched’ a $20 billion company in just 4 months (August 19, 2026)
In Get Off The Dime, I argued that employers needed to stop treating healthcare as an unavoidable cost of doing business and start behaving like sophisticated purchasers.
That worked until 2008 when the ACA rolled in and dynamics shifted with employers waiting it out
Insurers and hospitals have quickly learned to play the game to their advantage.
The problem is not simply that hospitals charge more, insurers raise premiums or pharmaceutical companies develop expensive drugs. The deeper problem is that employers have never built the infrastructure necessary to understand the entire economic system they are financing.
Consider the extraordinary amount of sophistication that exists inside today’s corporations. Companies know how much they spend on electricity, cloud computing, office space, transportation, raw materials and employee travel. They can analyze suppliers, compare prices, identify anomalies and negotiate contracts using sophisticated data systems.
Healthcare remains different.
The employer may be responsible for a substantial portion of the cost, but the information necessary to understand that cost can be scattered across claims databases, pharmacy systems, third-party administrators, provider contracts, insurers and a growing collection of point solutions.
While every other part of the business has evolved using AI , corporate benefits have never made that leap and they have no control over their own data necessary to make purchasing decisions and .
That is the fundamental problem.
And now the other side of the transaction is becoming considerably more sophisticated.
Hospitals and health systems are increasingly using artificial intelligence and advanced revenue-cycle technology to improve coding, identify missed charges and increase collections.
But employers need to understand what this means for the purchasing relationship. The organizations receiving healthcare dollars are becoming increasingly sophisticated at managing the revenue flowing into their systems, while many of the organizations providing those dollars still lack the tools to understand where the money is going.
At the same time, utilization is changing rapidly. Cancer treatments and specialty drugs can cost hundreds of thousands of dollars. GLP-1 medications are becoming increasingly prevalent. Aon reported that employee utilization of GLP-1 medications for weight loss increased 75 percent among its clients in 2025. These medications may provide tremendous value to patients, but they also raise complicated questions for employers about utilization, duration, cost and long-term return on investment.
And that exposes another problem that has remained unresolved for decades: we have placed responsibility for managing one of the most complicated financial transactions in corporate America primarily within human resources.
HR executives are experts in human capital, compensation, organizational culture and employee relations. They are not necessarily healthcare economists, physicians, actuaries, financial analysts or data scientists. Yet today’s healthcare marketplace requires an understanding of all of those disciplines.
The explosion of artificial intelligence makes the gap even more consequential.
The traditional benefits consultant was designed for an earlier era. Consultants helped employers negotiate renewals, benchmark premiums, design benefits and communicate changes to employees. Those services remain useful, but they are no longer sufficient.
An employer does not need another report telling it that healthcare costs increased 10 percent.
It needs to know why.
Was the increase driven by hospital prices, utilization, specialty drugs, cancer claims, emergency department use, inappropriate care, provider consolidation or changes in contract terms? Which providers are driving the increase? What is the employer actually paying compared with other purchasers? Where is there negotiating leverage?
Those questions require much more than a benefits consultant and much more than another analytics dashboard.
For years, the healthcare technology industry has responded by building software-as-a-service platforms that aggregate data and present it visually to employers. But putting fragmented data into a dashboard does not necessarily create purchasing intelligence.
The next generation of healthcare technology will have to do more than show employers what happened. It will have to explain why it happened, identify opportunities and help employers act.
That requires something healthcare has historically lacked: the integration of clinical intelligence, financial intelligence and technology.
The biggest obstacle is still data.
Healthcare data exists in thousands of places, often controlled by different organizations with different incentives. The employer may ultimately foot the bill, but it may not control the information required to understand the transaction. Without that information, purchasing power is largely theoretical.
This is perhaps the strangest economic relationship in American business. Employers and their employees are collectively paying enormous amounts for healthcare, yet the entities paying the bills often have less information about the transaction than the entities receiving the money.
Imagine Amazon operating its supply chain that way.
It would be unthinkable.
Yet that is essentially how healthcare works.
Some of the most sophisticated companies in the world have tried to change this. Amazon, JPMorgan Chase and Berkshire Hathaway created Haven in 2018 and recruited physician and Dr Atul Gawande to lead an effort to rethink healthcare for their employees. Haven ultimately shut down less than three years later.
READ: Sreedhar Potarazu | Who wrote this? The crisis of authorship — Vedas, Shakespeare and now, AI (August 18, 2026)
The failure was not a demonstration that these companies lacked resources or intelligence. It demonstrated how difficult it is to change a system in which information, incentives and purchasing relationships are fragmented across so many organizations.
That is why today’s crisis presents an opportunity.
The answer cannot simply be to shift more costs onto employees through higher premiums, deductibles and copayments. That may reduce the employer’s immediate expense, but it does not make healthcare more efficient. It simply moves the burden from the corporate balance sheet to the household balance sheet.
Employers need to become better purchasers.
That means treating healthcare with the same financial discipline they apply to every other major corporate expenditure. It means giving the CFO and CEO meaningful visibility into healthcare spending. It means using AI to understand the clinical and financial drivers of that spending. And it means developing the negotiating power necessary to act on that information.
In 2009, when I wrote Get Off The Dime, I believed employers needed to stop accepting the healthcare system as something they simply had to endure.I still believe that.
The difference is that companies can no longer afford to wait.
It is a corporate financial obligation large enough to affect profitability, employee compensation and shareholder value.
The companies that recognize that change will have an opportunity to do what employers have been trying, and largely failing, to do for decades: turn their enormous purchasing power into actual leverage.
The technology now exists to make that possible. Artificial intelligence can finally help employers connect the enormous amount of fragmented data surrounding healthcare spending and identify patterns that were previously impossible to see.
But technology alone is not enough.
The real transformation will occur when companies begin treating healthcare purchasing as a strategic corporate function requiring the combined expertise of medicine, finance and technology.
I wrote Get Off The Dime in 2009 because I believed employers had waited long enough.
Nearly two decades later, they have waited even longer.
The question now is whether double-digit healthcare increases will finally force corporate America to get off the dime using AI.