Episode Details

Welcome back to a special encore presentation of Turn on the Lights!

As we continue our transition series, our new host, Dr. Philip, has selected one of our most impactful and widely listened-to conversations from the archives to revisit. He introduces this timely discussion with Chris Van Gorder, which explores how cost shifting, regulatory mandates, and Medicare Advantage risk transfer are pushing healthcare toward structural unaffordability.

Summary:

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.

About Chris Van Gorder:

Chris Van Gorder, MPA, FACHE, is the President and Chief Executive Officer of Scripps Health in San Diego, where he has led the organization since 2000 after serving as its Chief of Healthcare Operations and COO. A veteran healthcare executive with decades of experience across California hospital systems, he previously held CEO and senior leadership roles at Long Beach Memorial Medical Center, Anaheim Memorial Medical Center, and Little Company of Mary Hospital. Beyond health system leadership, he has served on multiple boards, including Prolacta Bioscience and previously Abiomed and Z-Medica, and he has been active in national and civic service as a commissioner for the U.S. National Commission for UNESCO. He also brings an uncommon public-safety background, including reserve service with the San Diego Sheriff’s Department and long-running involvement with California’s Emergency Medical Services Authority, earning a Distinguished Service Medal. An educator and author, he teaches at USC and wrote The Front-Line Leader (2014).

Things You’ll Learn:

• Healthcare executives are dealing with an unprecedented volume of simultaneous operational, financial, and workforce demands, raising the stakes of everyday decisions. 

• Affordability isn’t just a household problem; it’s a system design problem that forces hospitals to cover the growing cost of unpaid care. 

• Cost shifting is not a theory; it is the mechanism that pushes public underpayment onto commercial premiums. 

• Regulatory and capital mandates can dramatically raise costs without generating new revenue, especially in California. 

• Medicare Advantage often adds friction through narrow networks, prior authorization, and payment disputes, while shifting risk downhill.

• Walking away from bad contracts can stabilize a system financially, but it creates real disruption for patients and exposes policy gaps in switching coverage.

Resources:

• Connect with and follow Chris Van Gorder on LinkedIn.

• Follow Scripps Health on

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