The medical-industrial complex is shorthand for how insurers, hospitals, and providers are structured to bill separately for a single episode of care: a monthly premium, a copay at the visit, and sometimes a bill afterward from a provider you never chose. A Netflix subscription is a useful comparison for how that feels to the person paying it.
A Netflix Metaphor for Healthcare Billing
Thank you to Taylor Black for the inspiration.
You pay your Netflix subscription every month. Then you watch a show, and there’s an extra charge for that episode. A few months later, a bill shows up for one of the actors, someone who was never actually part of your Netflix plan.
Netflix would never do that to you. Your health insurance does it routinely.
- Netflix is your insurance company.
- The shows and movies are your physician visits and facility visits: the ones you pay for on top of your premium.
- The surprise bill is the out-of-network provider who treated you without you ever choosing them.
Does the No Surprises Act Stop This?
Partly. The federal No Surprises Act, in effect since January 2022, bans balance billing for most emergency care and for certain out-of-network providers, such as anesthesiologists, radiologists, and pathologists, who treat you at an in-network hospital or surgical center.
It has real gaps. Non-emergency care at an out-of-network facility isn’t covered. Ground ambulance rides aren’t covered in most states. And a provider can still ask a patient to sign a written waiver of these protections for certain scheduled, non-emergency services.
So the specific surprise bill in the metaphor happens less often than it used to. What the law does not touch is the underlying structure: a premium every month, a copay or deductible at every visit, layered on top of each other before anyone reaches actual care.
What Employers Can Do About the Underlying Problem
None of the premium-plus-copay-plus-deductible stacking is required. Employers can add a Section 125 little concierge benefit that gives employees 24/7/365 primary, urgent, and mental health care: no copay, no deductible, no visit limits. It sits alongside a major medical plan rather than replacing it, and it gives employees a first stop for care that doesn’t generate a bill after the fact.
For the employer, that combination of real access and predictable cost is the point: fewer emergency room visits for non-emergencies, fewer missed workdays, and a benefit employees actually use.
There is a better way. Contact me to find out more.
