By MATT McCORD
American manufacturing is making a comeback. Driven by tariffs, supply chain instability, and shifting economic priorities, companies are reshoring production—reinvesting in U.S. labor and operations.
But there’s one major obstacle still standing in the way: the crushing cost of American healthcare.
For decades, U.S. employers have overpaid for healthcare without improving outcomes. Ballooning insurance premiums bloated administrative costs, and an opaque, middleman-driven system have left businesses with the highest healthcare costs in the world—twice as much as top global competitors.
If manufacturing is returning, shouldn’t we be demanding a more efficient and productive healthcare model to support it? The same industries that once offshored to escape labor costs must now confront the reality that the old way of buying healthcare is broken.
The Consolidated Appropriations Act (CAA) & The Growing Fiduciary Risk
The game has changed. The Consolidated Appropriations Act (CAA) of 2021 imposes strict new fiduciary requirements on employers that sponsor health plans. Companies can no longer blindly trust big insurance carriers or PBMs to act in their best interest.
If businesses fail to properly manage their healthcare spend, they are now liable for excessive costs, lack of transparency, and conflicts of interest.
This isn’t just theoretical—JP Morgan Chase is now facing a class-action lawsuit over how it managed its employee health plan, with board members named as defendants.
Employers have always scrutinized office supply costs, travel budgets, and vendor contracts—yet they’ve handed over healthcare procurement to third-party insurers with zero accountability.
Now, that lack of oversight is a legal risk.
Why Employers Need a Chief Health & Benefits Officer (CHBO)
Every major business function has an executive leader ensuring strategy, efficiency, and accountability:
- CFOs manage financial health with precision.
- COOs streamline operations for maximum productivity.
- CIOs leverage technology to drive innovation.
So why do we continue to let third-party insurers and middlemen dictate healthcare purchasing without a dedicated executive overseeing the strategy?
Mark Cuban recently called for a new C-suite role: the Healthcare CEO (HCEO). A more appropriate and less confusing term may be the Chief Health & Benefits Officer (CHBO). This leader would act as a fiduciary to the company, ensuring that its health benefits strategy delivers better outcomes at lower costs—just like a CFO does with financial oversight.
This isn’t a job for HR.
Most CHROs are already managing compensation, talent strategy, DEI, workforce development, compliance, and more. Expecting HR to also master complex healthcare contracting, negotiate with PBMs, and enforce fiduciary accountability is unrealistic and unfair.
A Chief Health & Benefits Officer would ensure:
Walking away from wasteful industry incumbents (big insurance carriers, opaque PBMs, overpriced hospital networks).
Building custom health benefit plans with direct contracts and value-based care.
Using a pass-through PBM to ensure drug pricing transparency and lower costs.
Eliminating middlemen that add cost without improving care.
Negotiating like a CFO—treating healthcare as a business expense, not a sunk cost.
The Wrong Approach: Cost Shifting is Not a Solution
For years, businesses have responded to rising healthcare costs by pushing the financial burden onto employees—higher deductibles, increased out-of-pocket expenses, and restrictive networks.
But a workforce buried in medical debt, avoiding care, or battling chronic conditions without treatment is not a productive workforce. Instead of asking,
“How much more can we make employees pay?”
we should be asking,
“How much can we save by purchasing healthcare smarter?”
A Fiduciary Approach to Healthcare Purchasing
Just as a CFO would never let a company overpay for raw materials, a CHBO would never let a company overpay for healthcare.
This means adopting modern, fiduciary-driven healthcare procurement strategies such as:
Transparent pricing and direct contracting with high-quality providers.
Pass-through PBMs that eliminate spread pricing and rebate traps.
Advanced primary care and on-site clinics that reduce hospitalizations and ER visits.
Customizable health plans that fit the company’s workforce needs—not a one-size-fits-all insurance carrier plan.
The best companies don’t tolerate inefficiency in any other major expense, so why should healthcare be any different?
Call to Action: It’s Time for Bold Action
The legal risks of ignoring healthcare procurement have never been higher.
Companies that embrace CHBO leadership and fiduciary-driven healthcare purchasing will gain a massive competitive advantage. They’ll spend less on waste, provide better benefits, and attract top talent.
The companies that stick with the status quo? They’ll continue overpaying, facing lawsuits, and struggling with rising costs.
Manufacturing is returning to America. But without fixing the broken healthcare system, we risk driving it away again.
It’s time for bold leadership. It’s time for the CHBO.
Matt McCord, MD is an anesthesiologist and founder of Opioid Free Solutions and Benesan.org, helping employers address overprescribing while modernizing health benefits purchasing
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