The Train Wreck That is U.S. Healthcare (And What to Do About It)

Nikhil Krishnan is the founder and author of Out of Pocket Health, a newsletter featuring in-depth analysis and clever memes about the state of the healthcare system in the United States today. While most of us will tune out as soon as anybody mentions the word “healthcare” or “insurance,” Nikhil brings a fresh and fun perspective to the topic of healthcare that is also informative and educational.

Listen in as we discuss the nitty-gritty of the current healthcare system in the US, including whether premiums are going up or down and whether you should be expecting a refund from your insurance company this year. We also talk about the two biggest problems in the US system today, the dichotomy between the US being a leader in cutting edge technology while also having an issue with access to basic healthcare for many, and we dive into the options for small businesses who want to provide health insurance for their employees.

You'll learn:

  • The two reasons why healthcare in the US is such a disaster. (5:05)
  • Employers and healthcare, and what is a uniquely US problem. (7:30)
  • Nikhil’s thoughts on a single payee system. (10:40)
  • Where healthcare premiums are now and where they are going. (14:10)
  • What the options are for employers who want to provide health insurance for employees. (17:15)
  • The two types of HRAs. (22:25)
  • Are there actually good catastrophic plans? (31:05)
  • Nikhil's thoughts on direct primary care. (40:00)
  • What is the future of US healthcare? (43:50)

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(With your host Andrew Youderian of and Nikhil Krishnan of

What Was Mentioned

Ideas Worth Sharing:

“Our antitrust laws are really not equipped to handle healthcare.” – @nikillinit
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“Health insurers can only keep 15-20% of their premium dollars for non-claims related things.” – @nikillinit
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“Healthcare ministry has really put the onus on individuals to do the shopping of healthcare.” – @nikillinit
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