America’s Newest Healthcare Industry Is Protecting Us From American Healthcare

On August 20, benefits consulting firm Aon reported that employer healthcare costs are expected to rise 9.5% in 2027, pushing average spending above $19,000 per employee. That would make 4 consecutive years of near double-digit increases. Employers still absorb most of the cost, although employees are paying more too.[1]

Somewhere inside that increasingly expensive arrangement, employers have acquired another bill.

After paying for health insurance, many are now paying an entirely separate industry to help their employees figure out how to use it.

I was finishing work on my Patient Survival Guide when I hit the section on private patient advocates and healthcare navigation. You know, trained professionals and companies you can hire to fight denials, decipher bills, coordinate specialists, find care, deal with insurance and generally figure out what the hell everyone else in healthcare is doing to you.

And it hit me like that bus hit Regina George.

We have created a secondary economy to protect Americans from the primary economy.

American healthcare has basically become a 1980s cable package. First you pay for HBO. Then you need the descrambler box. Then you need another guy to come over because nobody knows why Channel 4 is suddenly showing snow.

Except this isn’t The Cable Guy. It’s your chemotherapy deep-fried in an EOB with a side of AI denials.

Healthcare Did Not Suddenly Become Harder to Practice. It Became Harder to Use.

We have professionalized this work to an impressive degree.

The national Board Certified Patient Advocate examination contains 150 multiple-choice questions. Candidates must provide 2 letters of recommendation and meet education or equivalent-experience requirements. The Patient Advocate Certification Board administers the credential.[2]

This is a legitimate profession with credentials and standards because navigating healthcare has become a legitimate professional skill.

The Alliance of Professional Health Advocates operates the Umbra Health Advocacy directory. Umbra lists services ranging from medical-bill assistance at $200 an hour to insurance navigation and complex-care advocacy at $300 an hour.[3] Greater National Advocates, a nonprofit founded after its founder survived a preventable medical crisis that left him a quadruple amputee, describes itself as the nation’s largest public directory of independent patient advocates.[4]

Private advocates, billing specialists, benefits navigators, professional associations, credentialing boards and venture-backed technology companies now occupy an economy that barely needed explaining a generation ago.

And to be clear, I am not making fun of these people.

I’ve spent 30 years in American healthcare, beginning with brain cancer at 21, and there have been plenty of moments when I would have happily hired someone whose entire job was figuring out which person, department, insurer, specialist, pharmacy or administrative oubliette had possession of whatever I needed next.

That is precisely what makes this interesting.

The people doing this work did not create the maze. They showed up because somebody needed a flashlight.

Complexity Has Become a Market

Grand View Research estimates that U.S. healthcare navigation platforms generated nearly $3.9 billion in revenue in 2023 and projects the market will reach approximately $6.4 billion by 2030. Globally, it projects a $17.7 billion market by the end of the decade.[5]

We are spending billions of dollars helping people obtain, coordinate, understand and pay for healthcare they are already spending billions of dollars to have.

Solace Health offers a particularly vivid example. Founded in 2022, the patient-advocacy company raised $130 million in February 2026 in a financing round led by IVP, with participation from Menlo Ventures, SignalFire and others. The financing valued the company above $1 billion. Solace connects patients with advocates who help them schedule appointments, navigate diagnoses, coordinate care, obtain approvals and understand medical bills.[6]

I don’t begrudge Solace its valuation.

If someone can help a frightened, sick person get through this mess, more power to them.

Because somewhere underneath every TAM calculation and venture round is an actual person who may have cancer, a sick parent, a kid who needs treatment, a denied medication, 4 specialists who don’t talk to one another, a job they are trying not to lose and a medical bill written in hieroglyphics.

That person does not need an economics lecture.

They need help.

But a billion-dollar valuation also tells us investors see an enormous and durable market in Americans needing professional assistance to use American healthcare.

That should make us at least a little uncomfortable.

The economics are peculiar. Simpler insurance creates less need for navigation. Transparent billing creates less need for billing assistance. Care that can be coordinated without hiring someone to coordinate it leaves less work for companies selling coordination.

Nobody running these businesses needs to root for healthcare to become more confusing.

Business models don’t require villains.

They do, however, require customers.

There are important differences among the companies entering this market. Claimable, which counts Mark Cuban among its investors, uses AI to help patients appeal denied insurance claims.[7] A denial is challenged and, ideally, reversed. The obstacle goes away.

Other navigation businesses operate across a broader landscape in which their potential market grows as patients require more help managing the system.

Those are not morally equivalent observations about the companies involved.

They are economic observations about what produces demand.

Employers Are Paying for Both Sides of the Problem

Aon’s numbers make the arrangement especially strange for employers.

Companies already pay enormous amounts for coverage. They hire brokers and consultants, select plans, negotiate benefits and pay insurers. Grand View Research identifies large enterprises as the largest end-user segment for healthcare navigation platforms, meaning many employers then pay another company because their employees cannot reliably understand or use the benefits everyone just spent so much money purchasing.[5]

Accounting departments may place those expenses in different columns.

The money still leaves the same building.

And that may be the part of this conversation employers should pay closer attention to.

Navigation can absolutely produce value. An employee who gets the right care sooner, resolves a denial, avoids an unnecessary bill or successfully coordinates a complicated treatment plan may be healthier, less distracted and less likely to spend 11 hours of the workweek screaming into an insurer’s phone tree while contemplating arson.

Fine.

But eventually someone should be allowed to ask why the benefit requires another benefit to make the benefit usable.

That is not an argument against navigation. It is an argument for looking at the entire cost of complexity instead of pretending every new layer exists independently of the layer beneath it.

The People Solving the Problem Aren’t the Problem

None of this is an argument against patient advocates.

Quite the opposite.

Anyone who has fought an insurance denial while sick, tried to coordinate specialists who seem to communicate by carrier pigeon, or opened a medical bill apparently translated from some lost administrative language understands why advocates exist.

Good ones can turn an impossible situation into a manageable one, and they deserve to be paid for doing it.

What deserves scrutiny is why we need so many of them.

This is part of the same machinery I’ve spent decades trying to understand, and eventually wrote We the Patients to name: American healthcare does not have one discrete complexity problem. It has accumulated layers of incentives, intermediaries, administrative systems and workarounds until navigating the machinery itself became labor.

Sometimes unpaid labor performed by the patient.

Sometimes unpaid labor performed by the caregiver.

Sometimes administrative labor performed by a physician or nurse who would rather be practicing medicine.

And increasingly, paid labor performed by an entirely separate professional or company hired to get everyone through it.

American healthcare has an extraordinary talent for converting its own complications into somebody else’s commercial opportunity. Once enough people need help with a problem, the problem can support companies, contracts, jobs, revenue forecasts and investors.

Eventually an ecosystem develops around managing something we might otherwise have concentrated on eliminating.

That does not mean navigation companies are conspiring to preserve complexity. Most are solving real problems for real people, and often doing it very well.

The problem is more mundane than conspiracy and probably harder to unwind.

An industry can provide genuine value while depending economically on the persistence of the conditions that created it.

Employers, meanwhile, continue paying the original bill. Then they pay brokers and consultants to administer it. Increasingly, they pay navigators to help employees use it.

Patients pay too, sometimes directly in dollars and sometimes in time, fear, exhaustion and the peculiar unpaid second job of becoming competent in American healthcare because something terrible happened to them.

Healthcare costs rise, the system becomes harder to operate from the patient’s side, and another market grows around making the experience survivable.

There is something profoundly American about creating a healthcare industry to protect us from the healthcare industry we already had.

Making healthcare cheaper and simpler was never going to be easy.

Now complexity has a business model.