Leading a major health system today means juggling patient-first ethics with a financing model that keeps tightening the screws.

In this episode, Chris Van Gorder, President and Chief Executive Officer of Scripps Health, explains why health care is becoming structurally unaffordable amid soaring premiums, uncompensated emergency care, and rising input costs. He describes how hospitals have become the default safety net as county systems disappear, while underpayment by Medicare and Medicaid forces cost shifting onto employers and commercially insured patients. Van Gorder also highlights California’s seismic rebuilding mandates, which create massive capital pressure without matching reimbursement. He critiques managed care, value-based care, and Medicare Advantage for pushing risk onto providers through prior authorization and denials, recounting Scripps’ difficult decision to exit several Medicare Advantage contracts after heavy losses and the downstream impact on patients.

Tune in and learn how payment design, intermediaries, and regulation shape what hospitals can sustain and what patients can access.

Resources:

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